Douglas Alan Bergstrom, PH.D.
NPI 1063536688ActiveIndividual· Psychologist, Clinical· Prescott, AZ
Psychologist, Clinical (PH.D.) in Prescott, Arizona, licensed in AZ, with an NPI issued in March 2007. Medicare paid $22,954 for services to 15 patients in 2024.
Overview
| NPI | 1063536688 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PH.D. |
| Sole proprietor | Yes |
| NPI issued | Mar 19, 2007 |
| Last updated in NPPES | Jul 8, 2007 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | 1142 | AZ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Psychologist (AZ) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 15 |
|---|---|
| Services billed | 292 across 1 procedure code |
| Paid by Medicare | $22,954 |
Education and affiliations
| Graduation year | 1983 |
|---|---|
| Medicare specialty | Clinical Psychologist |
| Telehealth | Offers telehealth |
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All 25 clinical psychologists in Prescott · All clinical psychologists in Arizona