EDWARD CARL BERGEN (NPI# 1760454391) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760454391 |
| Entity Type | Individual |
| Full Name | EDWARD CARL BERGEN |
| Credential | D.O. |
| Practice Address |
1717 Oak Park Blvd 2nd Fl Lake Charles LA 70601-8991 |
| Mailing Address |
Po Box 122152 Dept 2152 Dallas TX 75312-2152 |
| Practice Telephone | 3374943278 |
| Practice Fax Number | 3374946969 |
| Mailing Telephone | 3374943278 |
| Mailing Fax Number | 3374306950 |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2016-10-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
DO000438 | LA | Allopathic & Osteopathic Physicians |
| Street Address |
1717 OAK PARK BLVD 2ND FL |
| City | LAKE CHARLES |
| State | LA |
| Zip Code | 70601-8991 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013910801 | William R Condos Jr. | Internal Medicine | 1717 Oak Park Blvd, Fl 2, Lake Charles, LA 70601-8990 | 2005-05-24 |
| 1467821629 | Courtney Clark | Nurse Practitioner | 1717 Oak Park Blvd, Lake Charles, LA 70601-8991 | 2015-09-17 |
| 1568845899 | Kathy Parker Woodward | Nurse Practitioner | 1717 Oak Park Blvd, 3rd Floor, Lake Charles, LA 70601-8991 | 2015-07-06 |
| 1356730303 | Rikki Monticello | Nurse Practitioner | 1717 Oak Park Blvd, 3rd Floor, Lake Charles, LA 70601-8991 | 2015-01-14 |
| 1831507961 | Rebecca Kindler | Optometrist | 1717 Oak Park Blvd, Ste 1, Lake Charles, LA 70601-8991 | 2014-08-01 |
| 1588007249 | Martin Daniel Castillo | Nurse Practitioner | 1717 Oak Park Blvd, 3rd Fl, Lake Charles, LA 70601-8991 | 2013-04-12 |
| 1043553522 | Amanda Joiner Saltzman | Pharmacist | 1717 Oak Park Blvd, Suite 110, Lake Charles, LA 70601-8991 | 2013-04-03 |
| 1932450210 | Keysha Raye Nabours | Nurse Practitioner | 1717 Oak Park Blvd, 2nd Fl, Lake Charles, LA 70601-8991 | 2012-09-26 |
| 1063778504 | Margaret Young Carter | Ophthalmology | 1717 Oak Park Blvd, #1, Lake Charles, LA 70601-8991 | 2012-04-10 |
| 1598052052 | Ted Etell Fontenot | Nurse Practitioner | 1717 Oak Park Blvd, Second Floor, Lake Charles, LA 70601-8991 | 2011-07-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144833872 | Fresenius Medical Care Sulphur, LLC | Clinic/Center | 330 Chavanne Street, Lake Charles, LA 70601 | 2020-08-24 |
| 1174158844 | Andrea Cormier | Peer Specialist | 751 E Bayou Pines Drive, Suite C, Lake Charles, LA 70601 | 2020-03-03 |
| 1588297303 | Vivian Claire Miller Monceaux | Chiropractor | 780 Bayou Pines East Drive, Lake Charles, LA 70601 | 2020-02-20 |
| 1568001014 | Swla Center for Health Services | Clinic/Center | 3820 Senator J. Bennett Johnston Ave, Charleston Bldg 8, Lake Charles, LA 70601 | 2020-01-02 |
| 1417512070 | Ryan Nathaniel Vaisler | Student in an Organized Health Care Education/Training Program | 1525 Oak Park Blvd., Lake Charles, LA 70601 | 2019-05-08 |
| 1336600675 | Hoh Palliative Care, LLC | Family Medicine | 750 East Bayou Pines, Suite A, Lake Charles, LA 70601 | 2019-03-28 |
| 1073079026 | Alawrass LLC | Pharmacy | 803 E Prien Lake Rd, Lake Charles, LA 70601 | 2019-02-14 |
| 1861962722 | Ellaweena Woods | Counselor | 1409 Kirkman St., Lake Charles, LA 70601 | 2018-12-04 |
| 1770051963 | Hanna Marie Rodriguez | Counselor | 751 Bayou Pines Drive, Suite C, Lake Charles, LA 70601 | 2018-11-06 |
| 1023585213 | Shandora Druilhet | Case Manager/Care Coordinator | 751 E Bayou Pines, Lake Charles, LA 70601 | 2018-10-26 |
| Find all providers in zip 70601 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902326572 | Southwest Louisiana Hospital Association | Internal Medicine | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2017-06-23 |
| 1184916371 | Mulhearn Medical, LLC | Internal Medicine | 600 Dr Michael Debakey Dr, Lake Charles, LA 70601-5727 | 2011-05-06 |
| 1235457870 | Brett Jared Goodwin | Internal Medicine | 501 Dr Michael Debakey Dr, Lake Charles, LA 70601-5724 | 2010-05-06 |
| 1083711006 | Cardiovascular Specialists of Southwest Louisiana, LLC | Internal Medicine | 600 Dr Michael Debakey Dr, Lake Charles, LA 70601-5727 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639633274 | Posina Enterprises LLC | Internal Medicine | 5911 Settlers Dr, Alexandria, LA 71303-6007 | 2019-01-28 |
| 1235638321 | Cardiac and Peripheral Vascular Services, LLC | Internal Medicine | 8050 W Judge Perez Dr Ste 2800, Chalmette, LA 70043-1740 | 2018-02-05 |
| 1629576996 | Cardiac Cin of Louisiana LLC | Internal Medicine | 3436 Magazine St Ste 550, New Orleans, LA 70115-2413 | 2018-01-31 |
| 1275031544 | Cardiac Cin of Baton Rouge LLC | Internal Medicine | 9655 Perkins Rd Ste C-220, Baton Rouge, LA 70810-1533 | 2018-01-31 |
| 1720423478 | Lafayette Cardiovascular Center of Excellence,llc | Internal Medicine | 318 Guilbeau Rd, Lafayette, LA 70506-6914 | 2013-05-08 |
| 1073820676 | Nurtured Heart, LLC | Internal Medicine | 324 Settlers Trace Blvd, Lafayette, LA 70508-6060 | 2010-09-03 |
| 1063724326 | Nayan Agarwal | Internal Medicine | 6550 Main St Ste 1000, Zachary, LA 70791-4092 | 2010-07-02 |
| 1164665477 | Salil Sethi | Internal Medicine | 3311 Prescott Rd Ste 112, Alexandria, LA 71301-3917 | 2009-04-16 |
| 1265687503 | Syed Bilal Akhtar Rizvi | Internal Medicine | 501 Medical Center Dr Ste 250, Alexandria, LA 71301-8124 | 2008-12-01 |
| 1972714889 | Sai Konduru | Internal Medicine | 2727 Hearne Ave Ste 301, Shreveport, LA 71103-3918 | 2007-05-24 |
| Find all providers with the same taxonomy | ||||
| City | LAKE CHARLES |
| Zip Code | 70601 |
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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.