Jeffrey Robert Bergstrom, MSW LCSW MPA is a medicare enrolled "Social Worker - Clinical" provider in Mullan, Idaho. His current practice location is
379 2nd Street, Mullan, Idaho. You can reach out to his office (for appointments etc.) via phone at
(307) 264-0114.
Jeffrey Robert Bergstrom is licensed to practice in Idaho (license number 40757) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1558840850.
Healthcare Provider's Profile
| Full Name | Jeffrey Robert Bergstrom |
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| Gender | Male |
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| Speciality | Social Worker - Clinical |
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| Location | 379 2nd Street, Mullan, Idaho |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1558840850
- Provider Enumeration Date: 08/08/2018
- Last Update Date: 12/27/2024
Medicare PECOS Information:
- PECOS PAC ID: 4183014285
- Enrollment ID: I20230113001427
Medical Identifiers
Medical identifiers for Jeffrey Robert Bergstrom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1558840850 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1041C0700X | Social Worker - Clinical | 100963 (California) | Secondary |
| 1041C0700X | Social Worker - Clinical | 4686 (Hawaii) | Secondary |
| 1041C0700X | Social Worker - Clinical | 49993 (Montana) | Secondary |
| 1041C0700X | Social Worker - Clinical | 40757 (Idaho) | Primary |
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. Jeffrey Robert Bergstrom allows following entities to bill medicare on his behalf.
| Entity Name | Family Health Centers Of San Diego Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1447281936
PECOS PAC ID: 3476446378
Enrollment ID: O20040204000923 |
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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. Jeffrey Robert Bergstrom 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 Address | Practice Location Address |
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Jeffrey Robert Bergstrom, MSW LCSW MPA
Po Box 444,
Mullan, ID 83846-0444
Ph: (208) 446-6758 | Jeffrey Robert Bergstrom, MSW LCSW MPA
379 2nd Street,
Mullan, ID 83846
Ph: (307) 264-0114 |
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