DOUGLAS ALAN BERGSTROM PH.D.
NPI 1063536688
Psychologist - Clinical in Prescott, AZ

Q: What is Douglas Bergstrom's NPI number?

The NPI number for Douglas Bergstrom is 1063536688. It was assigned to this individual provider in the NPPES registry on March 19, 2007.

Q: What is Douglas Bergstrom's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Douglas Bergstrom was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 19, 2007PECOS EnrolledAccepts Medicare Assignment

143 E MERRITT ST, PRESCOTT, AZ 86301(928) 445-3835(928) 445-7071 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Douglas Alan Bergstrom Ph.d. NPPES

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

DOUGLAS ALAN BERGSTROM PH.D. (NPI 1063536688) is an individual clinical provider in Prescott, Arizona, licensed in Arizona (1142) and active in the NPI registry since March 2007. He is enrolled in Medicare PECOS and is a graduate of Other (1983).

NPPES Registry Identity

NPI1063536688

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameDOUGLAS ALAN BERGSTROMCredential: PH.D.

Location Address143 E MERRITT STPrescott, AZ 86301-2028

Mailing Address143 E Merritt StPrescott, AZ 86301-2028 · (928) 445-3835 · Fax (928) 445-7071

Phone(928) 445-3835

Fax(928) 445-7071

Sole ProprietorYes

Medical School CMSOtherGraduated 1983

Enumeration DateMarch 19, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1063536688 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in AZ · 1142

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

143 E MERRITT ST, Prescott, AZ 86301

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health Plan, Inc., Providence Health Plan, UnitedHealthcare.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

Douglas Alan Bergstrom Ph.d. 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 ID9931134327

PECOS Enrollment IDI20051005000081

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

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.

Psychotherapy, 45 minutes 90834

Psychotherapy is a treatment method where you converse with a therapist about your thoughts, feelings, and behaviors. In a 45-minute session, the therapist assists you in understanding and managing your mental health concerns, improving emotional wellness, and promoting personal growth.

292 services15 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 86301 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

$168.60 typical visit price

range $55.44 – $168.60

Typical copayment $42.15 (range $13.86 – $42.15)

Most-billed visit code 99205

Established Patient

$98.00 typical visit price

range $17.72 – $137.41

Typical copayment $24.50 (range $4.43 – $34.35)

Most-billed visit code 99214

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 6

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

MRS. GAIL ANN WAGNER M.S.

Counselor (Mental Health)