Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Ethan Patrick Berg, DO

Individual provider Family Medicine Physician · NPI 1831629401

Dr. Ethan Patrick Berg, DO is a Family Practice in Springfield, Illinois. Qualified in 2017, 9 years ago. Practices with Board of Trustees of Southern Illinois University, a 142-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
9
Licensed in
IL
In the registry since
2017
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

520 N 4th St
Springfield, IL 62702-5238
Phone: (217) 545-8000
Fax: (217) 757-8161
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 125071205 (IL)

Record details

NPI number1831629401
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedJune 15, 2017
Last updated in NPPESJune 15, 2017
Mailing addressPo Box 19670, Springfield, IL 62794-9670

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Board Of Trustees Of Southern Illinois University — 142 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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