Individual ProviderJill C. BergNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7916 W Jefferson Blvd, Fort Wayne, IN 46804-4140(260) 432-2297(260) 479-3514PECOS EnrollmentBased on the most recent information from CMS, provider Jill C. Berg does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1447219951Provider TypeIndividualFull NameBerg, Jill C.CredentialNP-CGenderFemaleSole ProprietorNoEnumeration Date3/22/2006Last Updated12/18/2016Contact InformationPractice LocationPractice Address7916 W Jefferson Blvd, Fort Wayne, IN 46804-4140Phone(260) 432-2297Fax(260) 434-6433Mailing LocationMailing Address6920 Pointe Inverness Way Ste 200, Medpartners, Attn: Barb Copeland, Fort Wayne, IN 46804-7934Phone(260) 479-3514Fax(260) 479-3520Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71001258AIndianaProvider IdentifiersIDDescriptionIssuerID500022462DescriptionOtherIssuerRAILROADID000000289365DescriptionOtherIssuerANTHEMIndianaID200353910DescriptionMedicaidIssuerUnlistedIndianaID2454348DescriptionMedicaidIssuerUnlistedOhio