Lars Bergeson (NPI# 1497721195, PAC ID# 3375680945) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY PRACTICE.
| Nation Provider ID (NPI) | 1497721195 |
| PAC ID by PECOS | 3375680945 |
| Professional Enrollment ID | I20100125000229 |
| Full Name | Lars Bergeson |
| Organization Legal Name | MOUNTAINSTAR MEDICAL GROUP-CACHE VALLEY LLC |
| Address |
382 W 280 Providence UT 84332-9753 |
| Phone Number | 4357520330 |
| Gender | M |
| Medical School | MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE |
| Graduation Year | 1979 |
| Primary Specialty | FAMILY PRACTICE |
| Group Practice PAC ID | 5193887149 |
| Number of Group Practice Members | 7 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 460054 | CACHE VALLEY HOSPITAL |
| 460015 | LOGAN REGIONAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 2850 N 2000, Suite 101, Farr West, UT 84404-9264 | 8017311222 | MOUNTAINSTAR MEDICAL GROUP-CACHE VALLEY LLC |
| 382 W 280, Providence, UT 84332-9753 | 4357520330 | MOUNTAINSTAR MEDICAL GROUP-CACHE VALLEY LLC |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| ACI_EC_TRANS_PHCDRR_1 | Immunization Registry Reporting | % | |
| ACI_EC_TRANS_PHCDRR_3 | Specialized Registry Reporting | % | |
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % |
| Organization Legal Name | MOUNTAINSTAR MEDICAL GROUP-CACHE VALLEY LLC |
| Physicians | 6 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kevin R Duke | Family Medicine | Mountainstar Medical Group-cache Valley LLC | 382 W 280, Providence, UT 84332-9753 |
| Matthew J Welter | Family Medicine | Mountainstar Medical Group-cache Valley LLC | 2380 N 400, Suite A, North Logan, UT 84341-1756 |
| Mark Traveller Hansen | General Surgery | Mountainstar Medical Group-cache Valley LLC | 2380 N 400, Suite A, North Logan, UT 84341-1756 |
| Richard Thomas Stevens | Family Medicine | Mountainstar Medical Group-cache Valley LLC | 382 W 280, Providence, UT 84332-9753 |
| Nathan R Bertoldo | Obstetrics/gynecology | Mountainstar Medical Group-cache Valley LLC | 2380 N 400, North Logan, UT 84321 |
| Street Address |
382 W 280 |
| City | PROVIDENCE |
| State | UT |
| Zip | 84332-9753 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kevin R Duke | Family Medicine | Mountainstar Medical Group-cache Valley LLC | 382 W 280, Providence, UT 84332-9753 |
| Richard Thomas Stevens | Family Medicine | Mountainstar Medical Group-cache Valley LLC | 382 W 280, Providence, UT 84332-9753 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Spencer W Wade | Chiropractic | 565 W 465 N, Suite 140, Providence, UT 84332-4802 | |
| Vera Carlson | Family Medicine | 565 W 465, Suite 130, Providence, UT 84332-4802 | |
| Corey B Johnson | Emergency Medicine | 565 W 465 N, 130 Cache Vein Care, Providence, UT 84332-4802 | |
| Thomas Owen Fullmer X | Chiropractic | 1652s Hwy 165, Providence, UT 84332-6701 | |
| Nichole L Jardine | Clinical Social Worker | 545 W 465, Suite 130, Providence, UT 84332-8005 | |
| Thomas E Atkin | Clinical Psychologist | 545 W 465 N, Providence, UT 84332-8005 | |
| Jeremy William Broadhurst | Family Medicine | Ihc Health Services Inc | 190 S Hwy 165, Providence, UT 84332-9512 |
| Robert G Patterson | Family Medicine | Ihc Health Services Inc | 190 S Hwy 165, Providence, UT 84332-9512 |
| David A Smith | Optometry | 276 N Spring Creek Pkwy, Providence, UT 84332-9775 | |
| Steven S Garvert | Chiropractic | Springcreek Medical Center PC | 267 N Spring Creek Pkwy, Providence, UT 84332-9775 |
| Find all physicians in zip 84332 | |||
| City | PROVIDENCE |
| Zip Code | 84332 |
| Specialty | FAMILY PRACTICE |
| City + Specialty | PROVIDENCE + FAMILY PRACTICE |
Please comment or provide details below to improve the information on Lars Bergeson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.