Basic Information
| Provider Information | |||||||||
| NPI: | 1174560312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERKOMPAS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 WOODMONT BLVD | ||||||||
| Address2: | SUITE LL50 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153862300 | ||||||||
| FaxNumber: | 6153862399 | ||||||||
| Practice Location | |||||||||
| Address1: | 4230 HARDING RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152972700 | ||||||||
| FaxNumber: | 6152694584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 08/01/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 17891 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1058203 | 01 | TN | COVENTRY | OTHER | 798071 | 01 | TN | UNITED HEALTHCARE | OTHER | 10074030 | 01 | TX | AMERIGROUP-TENNCARE | OTHER | 3164293 | 01 | TN | BLUE CROSS OF TN | OTHER | 4113407 | 01 | TN | AETNA | OTHER | 633770 | 01 | TN | USA MANAGED CARE | OTHER | 3482983 | 01 | TN | CIGNA | OTHER | 1506399 | 05 | TN | MEDICAID | 64796691 | 05 | KY | MEDICAID | Q006395 | 05 | TN | MEDICAID | 1100342182 | 01 | TN | USA PPO-GEHA | OTHER | 110217706 | 01 | TN | MEDICARE RR | OTHER | 12075822 | 01 | TX | MULTIPLAN/PHCS | OTHER |