Jack William Bergman, PA-C - Medicare Physician Assistant in St Louis Park, MN

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Jack William Bergman, PA-C is a medicare enrolled "Physician Assistant" in St Louis Park, Minnesota. He graduated from nursing school in 2018 and has 8 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice Fairview Express Care, Fairview Specialty Services, Park Nicollet Clinic, Group Health Inc and his current practice location is 3931 Louisiana Ave S, St Louis Park, Minnesota. You can reach out to his office (for appointments etc.) via phone at (952) 993-3230.

Jack William Bergman is licensed to practice in Minnesota (license number 13280) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1043790553.

Contact Information

Jack William Bergman, PA-C
3931 Louisiana Ave S,
St Louis Park, MN 55426-5000
(952) 993-3230
(952) 993-1748

Map and Direction




Provider's Profile

Full NameJack William Bergman
GenderMale
SpecialityPhysician Assistant
Experience8 Years
Location3931 Louisiana Ave S, St Louis Park, Minnesota
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Jack William Bergman graduated from nursing school in 2018
  NPI Data:
  • NPI Number: 1043790553
  • Provider Enumeration Date: 08/15/2018
  • Last Update Date: 01/17/2020
  Medicare PECOS Information:
  • PECOS PAC ID: 5698029080
  • Enrollment ID: I20200129001261

Medical Identifiers

Medical identifiers for Jack William Bergman such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1043790553NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363A00000XPhysician Assistant 13280 (Minnesota)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Park Nicollet Methodist HospitalSaint louis park, MNHospital
M Health Fairview Southdale HospitalEdina, MNHospital
M Health Fairview Ridges HospitalBurnsville, MNHospital
M Health Fairview Lakes Medical CenterWyoming, MNHospital
M Health Fairview Woodwinds HospitalWoodbury, MNHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Fairview Express Care33756451791946
Fairview Specialty Services3072083286303
Park Nicollet Clinic79118194381778
Group Health Inc17592939541627

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jack William Bergman allows following entities to bill medicare on his behalf.
Entity NamePark Nicollet Clinic
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1780621904
PECOS PAC ID: 7911819438
Enrollment ID: O20031104000046
Entity NameGroup Health Plan Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1710924683
PECOS PAC ID: 1759293954
Enrollment ID: O20031105000417
Entity NameHealtheast Medical Research Institute
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1639125503
PECOS PAC ID: 3971407636
Enrollment ID: O20031124000507
Entity NameFairview Express Care
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1053952606
PECOS PAC ID: 3375645179
Enrollment ID: O20081028000548

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jack William Bergman is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Jack William Bergman, PA-C
3931 Louisiana Ave S,
St Louis Park, MN 55426-5000

Ph: (952) 993-3230		Jack William Bergman, PA-C
3931 Louisiana Ave S,
St Louis Park, MN 55426-5000

Ph: (952) 993-3230

Reviews and Comments


Physician Assistant Nurses in St Louis Park, MN

Amy Vandenberg, PA-C
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Practice Location: 3850 Park Nicollet Blvd, St Louis Park, MN 55416
Phone: 952-883-1000    
Kelsey Widmyer Israelson, PA
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Kelly C Greco, PAC
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Practice Location: 3800 Park Nicollet Blvd, Department Of Dermatology, St Louis Park, MN 55416
Phone: 952-993-3260    Fax: 952-993-0333
Ms. Maggie J Koch, O.A.
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Lucia F Pierson, OPA
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Phone: 952-993-7169    Fax: 952-993-0300
Tamara A Johnson, PA-C
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Medicare: Medicare Enrolled
Practice Location: 6490 Excelsior Blvd, Ste W200, St Louis Park, MN 55426
Phone: 952-993-3180    
Mrs. Ann Marie Strong, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: Park Nicollet Clinic-smartcare, 3800 Park Nicollet Blvd Suite 150, St Louis Park, MN 55416
Phone: 952-993-1190    Fax: 952-993-0960

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.