Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jack William Bergman, PA-C

Individual provider Physician Assistant · NPI 1043790553

Jack William Bergman, PA-C is a Physician Assistant in St Louis Park, Minnesota. Qualified in 2018, 8 years ago. Practices with Fairview Express Care, a 1,964-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
8
Licensed in
MN
In the registry since
2018
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3931 Louisiana Ave S
St Louis Park, MN 55426-5000
Phone: (952) 993-3230
Fax: (952) 993-1748
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 5838 Six Forks Rd Ste 100, Raleigh, NC 27609-3893 — (919) 785-3400

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 13280 (MN)

Record details

NPI number1043790553
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 15, 2018
Last updated in NPPESJanuary 17, 2020
Certification dateJanuary 17, 2020

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Fairview Express Care — 1964 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations13 on file with Medicare

Other providers in St Louis Park