Jodi Ann Bergstrom, OD is a medicare enrolled "Optometrist" provider in Centuria, Wisconsin. Her current practice location is
416 Superior Avenue, Centuria, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(715) 646-1336.
Jodi Ann Bergstrom is licensed to practice in Wisconsin (license number 2281) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1568511095.
Healthcare Provider's Profile
| Full Name | Jodi Ann Bergstrom |
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| Gender | Female |
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| Speciality | Optometrist |
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| Location | 416 Superior Avenue, Centuria, Wisconsin |
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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: 1568511095
- Provider Enumeration Date: 01/10/2007
- Last Update Date: 09/04/2024
Medicare PECOS Information:
- PECOS PAC ID: 3779680483
- Enrollment ID: I20070515000039
Medical Identifiers
Medical identifiers for Jodi Ann Bergstrom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1568511095 | NPI | - | NPPES |
| 38594500 | Medicaid | WI | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | 1643 (Nebraska) | Secondary |
| 152W00000X | Optometrist | 2231 (Minnesota) | Secondary |
| 152W00000X | Optometrist | 4901005835 (Michigan) | Secondary |
| 152W00000X | Optometrist | TPOP218 (Florida) | Secondary |
| 152W00000X | Optometrist | 2281 (Wisconsin) | 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. Jodi Ann Bergstrom allows following entities to bill medicare on her behalf.
| Provider Name | Visionworks Inc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1154699445
PECOS PAC ID: 4385639616
Enrollment ID: O20120517000227 |
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| Provider Name | Myeyedr Optometry Of Wisconsin Llc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1164992996
PECOS PAC ID: 5890033716
Enrollment ID: O20190219000001 |
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| Provider Name | Hull & Williquette Ltd |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1982772547
PECOS PAC ID: 8123436052
Enrollment ID: O20210414001330 |
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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. Jodi Ann 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 |
|---|
Jodi Ann Bergstrom, OD
416 Superior Avenue, Po Box 400,
Centuria, WI 54824
Ph: (715) 646-1336 | Jodi Ann Bergstrom, OD
416 Superior Avenue,
Centuria, WI 54824
Ph: (715) 646-1336 |
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