JACK WILLIAM BERGMAN PA-C
NPI 1043790553
Physician Assistant in St Louis Park, MN

Active since August 15, 2018PECOS EnrolledAccepts Medicare Assignment
3931 LOUISIANA AVE S, ST LOUIS PARK, MN 55426(952) 993-3230(952) 993-1748 Get Directions Write a Review

NPPES record last updated: January 17, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 17, 2020, Aug 15, 2018 (2 updates tracked since 2018).

About Jack William Bergman Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK WILLIAM BERGMAN PA-C (NPI 1043790553) is an individual physician assistant in St Louis Park, Minnesota, licensed in Minnesota (13280) and active in the NPI registry since August 2018. He is enrolled in Medicare PECOS, is affiliated with Park Nicollet Methodist Hospital, and maintains a secondary practice location in Raleigh.

NPPES Registry Identity

NPI1043790553
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameJACK WILLIAM BERGMANCredential: PA-C
Location Address3931 LOUISIANA AVE SSt Louis Park, MN 55426-5000
Mailing Address3931 Louisiana Ave SSt Louis Park, MN 55426-5000 · (952) 993-3230 · Fax (952) 993-1748
Fax(952) 993-1748
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateAugust 15, 2018
Last NPPES UpdateJanuary 17, 20202 updates tracked since enumeration
NPI 1043790553 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in MN · 13280
Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

3931 LOUISIANA AVE S, St Louis Park, MN 55426

Secondary Practice Location 1

Location 15838 Six Forks Rd Ste 100Raleigh, NC 27609-3893 · Phone (919) 785-3400 · Fax (919) 783-7778

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Jack William Bergman Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5698029080
PECOS Enrollment IDI20200129001261
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
30 services30 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
16 services15 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Park Nicollet Methodist Hospital

Acute Care Hospitals · Saint Louis Park, MN
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number240053
Location6500 Excelsior BlvdSaint Louis Park, MN 55426 · Hennepin County
Emergency services Birthing friendly

M Health Fairview Southdale Hospital

Acute Care Hospitals · Edina, MN
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number240078
Location6401 France Avenue SouthEdina, MN 55435 · Hennepin County
Emergency services Birthing friendly

M Health Fairview Ridges Hospital

Acute Care Hospitals · Burnsville, MN
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number240207
Location201 East Nicollet BoulevardBurnsville, MN 55337 · Dakota County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55426 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner
3931 LOUISIANA AVE S
ST LOUIS PARK, MN 55426
Internal Medicine (Pulmonary Disease)
3931 LOUISIANA AVE S
SAINT LOUIS PARK, MN 55426
Obstetrics & Gynecology (Maternal & Fetal Medicine)
3931 LOUISIANA AVE S, STE E111
ST LOUIS PARK, MN 55426
Internal Medicine (Pulmonary Disease)
3931 LOUISIANA AVE S
ST LOUIS PARK, MN 55426
Counselor (Professional)
3931 LOUISIANA AVE S
SAINT LOUIS PARK, MN 55426
Physician Assistant
3931 LOUISIANA AVE S
SAINT LOUIS PARK, MN 55426
Nurse Practitioner (Family)
3931 LOUISIANA AVE S
ST LOUIS PARK, MN 55426
Obstetrics & Gynecology (Maternal & Fetal Medicine)
3931 LOUISIANA AVE S
ST LOUIS PARK, MN 55426

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Bergman's NPI number?

The NPI number for Jack Bergman is 1043790553. It was assigned to this individual provider in the NPPES registry on August 15, 2018.

Where is Jack Bergman located?

Jack Bergman practices at 3931 Louisiana Ave S, St Louis Park, MN 55426. The listed phone number is (952) 993-3230.

What is Jack Bergman's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Jack Bergman enrolled in Medicare?

Yes. Jack Bergman is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Jack Bergman accept?

Health plans from HealthPartners and Medica list Jack Bergman as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Jack Bergman affiliated with any hospitals?

According to CMS data, Jack Bergman is affiliated with Park Nicollet Methodist Hospital, M Health Fairview Southdale Hospital and M Health Fairview Ridges Hospital.

When was this NPI record last updated?

The NPPES record for Jack Bergman was last updated on January 17, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.