MARY ELLEN BERG (NPI# 1174524391) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174524391 |
| Entity Type | Individual |
| Full Name | MARY ELLEN BERG |
| Credential | M.D. |
| Practice Address |
471 Ashley Ridge Blvd Shreveport LA 71106 |
| Practice Telephone | 3187954770 |
| Practice Fax Number | 3187954775 |
| Mailing Telephone | 3187954770 |
| Mailing Fax Number | 3187954775 |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2009-01-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | 019001 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | ARKANSAS MEDICAID | 123802001 | 01 |
| TX | TEXAS MEDICAID | 078737601 | 01 |
| LA | GROUP MEDICARE NUMBER | 1053315846 | 01 |
| LA | 1922871 | 05 | |
| LA | RAILROAD MEDICARE | P00375906 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629595228 | Mary Camille Berg | Behavior Technician | 1408 20th Ave Sw Ste 7, Minot, ND 58701-6494 | 2017-08-24 |
| 1841483849 | Mary Gilbert Berg | Physical Therapist | 378 Middle Rd, Falmouth, ME 04105-1231 | 2007-08-22 |
| 1043331390 | Mary Berg | Nurse Practitioner | 10653 Douglas Ln, Nevada City, CA 95959-9010 | 2007-04-03 |
| 1790899839 | Mary Papez Berg | Dentist | 601 W Moana Ln, Suite 7, Reno, NV 89509-4955 | 2006-08-18 |
| 1477530871 | Mary Charlene Berg | Nurse Anesthetist, Certified Registered | 3535 S Interstate 35 E, Denton, TX 76210-6850 | 2005-12-27 |
| 1336352939 | Mary Eileen Berg | Nurse Practitioner | 600 N Mountain Ave, Suite A104, Upland, CA 91786-4359 | 2007-05-08 |
| 1245372648 | Mary Jean Berg | Emergency Medicine | 1100 Carson Ave, La Junta, CO 81050-2751 | 2007-02-13 |
| 1487724290 | Mary A Berg | Family Medicine | 1312 Prentice Drive, Healdsburg, CA 95448 | 2006-11-09 |
| 1932210879 | Mary H Berg | Psychiatry & Neurology | 158 Zillicoa St, Asheville, NC 28801-1079 | 2006-08-31 |
| 1174596522 | Mary Berg | Pathology | 12605 E 16th Ave, Aurora, CO 80045-2545 | 2006-02-08 |
| Street Address |
471 ASHLEY RIDGE BLVD |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831192137 | John Paul Drummond | Ophthalmology | 471 Ashley Ridge Blvd, Shreveport, LA 71106-7229 | 2005-05-31 |
| 1477925063 | Highland Clinic, A Prof Med Corp | Ophthalmology | 471 Ashley Ridge Blvd, Shreveport, LA 71106-7229 | 2015-10-22 |
| 1235457979 | Ann H Guy | Ophthalmology | 471 Ashley Ridge Blvd, Shreveport, LA 71106-7229 | 2010-05-05 |
| 1043538796 | Claude Youngblood Bundrick Jr. | Ophthalmology | 471 Ashley Ridge Blvd, Shreveport, LA 71106-7229 | 2010-05-05 |
| 1326281874 | Mary Catherine Clemons | Ophthalmology | 471 Ashley Ridge Blvd, Shreveport, LA 71106-7229 | 2009-04-14 |
| 1518991504 | Shreveport Eye Clinic A Medical Corp | Ophthalmology | 471 Ashley Ridge Blvd, Shreveport, LA 71106 | 2006-07-10 |
| 1568460913 | Bruce C Henderson | Ophthalmology | 471 Ashley Ridge Blvd, Shreveport, LA 71106-7229 | 2005-07-11 |
| 1710981659 | Geoffrey W Garrett | Ophthalmology | 471 Ashley Ridge Blvd, Shreveport, LA 71106-7229 | 2005-06-09 |
| 1609879931 | Carol S Clemons | Ophthalmology | 471 Ashley Ridge Blvd, Shreveport, LA 71106-7229 | 2005-05-31 |
| 1518960848 | Jeffrey E. Faludi | Ophthalmology | 471 Ashley Ridge Blvd, Shreveport, LA 71106-7229 | 2005-05-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972008332 | Andrew Joseph Brouillette | Dentist | 385 Bert Kouns Industrial Loop Ste 700, Shreveport, LA 71106 | 2018-03-28 |
| 1548775885 | David Wayne Spears | Pharmacist | 10460 Norris Ferry Road, Shreveport, LA 71106 | 2017-12-08 |
| 1225559263 | Susan Anderson Roblow | Physical Therapist | 921 Unadilla Street, Shreveport, LA 71106 | 2017-06-29 |
| 1134656382 | James Lowder | Dentist | 8691 Line Ave Ste 300, Shreveport, LA 71106 | 2017-05-18 |
| 1144753708 | Laverne Brantley | Counselor | 328 E 69th St, Shreveport, LA 71106 | 2017-04-10 |
| 1437690849 | Biostat Laboratories, LLC | Clinical Medical Laboratory | 9742 Saint Vincent Ave Ste 200, Shreveport, LA 71106 | 2017-03-17 |
| 1841730728 | Cedric Thomas | Case Manager/Care Coordinator | 6811 Fairfield Avenue, Shreveport, LA 71106 | 2017-02-27 |
| 1225576192 | Nick Vergis | Pharmacist | 5828 Line Avenue, Shreveport, LA 71106 | 2017-02-10 |
| 1184162554 | Marilyn Johnson | Case Manager/Care Coordinator | 9245 Wallace Lake Rd Ste A, Shreveport, LA 71106 | 2017-02-06 |
| 1417499740 | Pamela Lee | Counselor | 8802 Coyth Ln, Shreveport, LA 71106 | 2016-11-17 |
| Find all providers in zip 71106 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043744196 | Aigerim B. Saulebayeva | Ophthalmology | 1501 Kings Hwy Bldg 1-201, Shreveport, LA 71103-4228 | 2017-04-16 |
| 1891168761 | Highland Clinic, A Prof Med Corp | Ophthalmology | 1400 E Bert Koun Loop, #103, Shreveport, LA 71105-5603 | 2015-11-02 |
| 1861838989 | James Vernon Ward | Ophthalmology | 413 Trinity Cir, Shreveport, LA 71106-2340 | 2013-05-15 |
| 1871781666 | Karen M'liss Pendleton | Ophthalmology | 6030 Line Ave, Suite 210, Shreveport, LA 71106-2062 | 2007-10-05 |
| 1295828374 | Jerry Welton Drummond | Ophthalmology | 2514 Bert Kouns Ind Loop, Physicians Plaza #9, Shreveport, LA 71118 | 2006-10-02 |
| 1356320568 | Jeffrey M Gosslee | Ophthalmology | 725 N Ashley Ridge Loop, Ste 400, Shreveport, LA 71106 | 2006-01-16 |
| 1235129818 | Donald L Hall | Ophthalmology | 2611 Greenwood Rd, Shreveport, LA 71103-3907 | 2005-10-25 |
| 1427045814 | M. Ashley Wheat-sipes | Ophthalmology | 7843 Youree Dr, Shreveport, LA 71105-5505 | 2005-09-30 |
| 1932105483 | Michael A Holy | Ophthalmology | 1801 Fairfield Ave, Ste 101, Shreveport, LA 71101-4457 | 2005-06-21 |
| 1386649788 | Wilson B Baber | Ophthalmology | 734 N Ashley Ridge Loop, Shreveport, LA 71106-7209 | 2005-06-14 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71106 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.