RUSSELL ALAN BERGUM (D.O.) – Sports Medicine (Family Medicine) Physician, NPI 1669400024
Sports Medicine (Family Medicine) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,656 FAMILY PRACTICE in IA
Provider Addresses for RUSSELL ALAN BERGUM (D.O.)
6151 Thornton Ave Ste 200
Des Moines, IA 503212413
Phone: (515) 421-4090
Fax: (402) 939-0407
Type: Location
2560 2ND ST SW STE 120
ROCHESTER, MN 559024363
Phone: (507) 361-0400
Fax: (866) 371-6710
Type: Location
Albert Lea Medical Center, 404, West Fountain Street, Albert Lea, Freeborn County, Minnesota, 56007, United States
ALBERT LEA, MN 560072437
Phone: (507) 373-2384
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $27.
Total Amount is formed as General ($27) + Research ($0) + Ownership ($0) = $27.
Last reported payment date: 2023-02-27 • Largest payer in this snapshot: Teleflex LLC ($27).
Total Amount
$27
General + Research + Ownership
Payments
1
Total payment records
General Amount
$27
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-02-27
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Teleflex LLC | $27 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-02-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240222001035 | I | Family Practice | IA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 50321)
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