Jack William Bergman, PA-C
NPI 1043790553ActiveIndividual· Physician Assistant· St Louis Park, MN
Physician Assistant (PA-C) with Fairview Express Care and 3 other groups, practicing in St Louis Park, Minnesota. 105 Medicare patients in 2024, $10,990 paid; nearly all of their 158 Part D prescriptions were generic (96%). Lists Fairview Lakes Health Services and 4 other hospitals as hospital affiliations.
Overview
| NPI | 1043790553 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PA-C |
| Sole proprietor | No |
| NPI issued | Aug 15, 2018 |
| Last updated in NPPES | Jan 17, 2020 |
| Certified by provider | Jan 17, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | 13280 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (MN) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 105 |
|---|---|
| Services billed | 156 across 35 procedure codes |
| Paid by Medicare | $10,990 |
Part D prescriptions in 2024
| Prescriptions (claims) | 158 · 167 30-day fills |
|---|---|
| Patients | 63 |
| Total drug cost | $1,256 |
| Generic share | 96% of claims |
Education and affiliations
| Graduation year | 2018 |
|---|---|
| Medicare specialty | Physician Assistant |
Medical groups
- Fairview Express CareMinneapolis, MN · 1,911 clinicians
- Park Nicollet ClinicSt Louis Park, MN · 1,787 clinicians
- Group Health IncBloomington, MN · 1,638 clinicians
- Fairview Specialty ServicesMaplewood, MN · 306 clinicians
Hospital affiliations
- Fairview Lakes Health ServicesWyoming, MN
- M Health Fairview Ridges HospitalBurnsville, MN
- M Health Fairview Southdale HospitalEdina, MN
- M Health Fairview St John's HospitalMaplewood, MN
- Park Nicollet Methodist HospitalSaint Louis Park, MN
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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