NPIMap

Individual provider Active NPI

Jeffrey M Burock, MD

  • Psychiatry Physician
  • Providence, RI
National Provider Identifier
1023096278
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD11229 Issued in RI
Practice address
164 Summit Ave
Providence, RI 02906-2853
Phone
(401) 793-4500
NPI assigned
Jan 7, 2006
Last updated
May 22, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD11229 RI Primary

Addresses

Primary practice location

164 Summit Ave
Providence, RI 02906-2853

Mailing address

PO Box 3238
Boston, MA 02241-3238
Phone (866) 689-8862

Other identifiers 3

IdentifierTypeStateIssuer
27982-4OtherRIBCBS RI
412095OtherRIBLUECHIP
7056846MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041101000761 RI Practitioner - PsychiatryPractitioner - Neurology 4486616588 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Neurology
Education
Creighton University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

11 Friendship St
Newport, RI 02840-2209
Phone (401) 845-1810

164 Summit Ave
Providence, RI 02906-2853
Phone (401) 793-4300

593 Eddy St
Providence, RI 02903-4923

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD11229RIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rhode Island Hospital Psychiatry CurrentSince Jun 13, 2018 Accepting new patients
The Miriam Hospital Psychiatry CurrentSince Jul 1, 2004 Accepting new patients
The Miriam Hospital CurrentSince Jul 1, 2004 Accepting new patients
Lifespan Physician Group, Inc. Psychiatry CurrentSince Mar 29, 2015 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Mar 29, 2015 Accepting new patients
Lifespan Corporation Current Accepting new patients
Rhode Island Hospital CurrentSince Jun 13, 2018 Accepting new patients
The Miriam Hospital Past Accepting new patients

Locations

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

200 Corliss St
#1
Providence, RI 02904
Phone (401) 606-8530

593 Eddy St
Providence, RI 02903

593 Eddy St
Ste 9B
Providence, RI 02903
Phone (401) 444-5280

Interoperability endpoints

  • Direct secure messaging: jburock11253@brownhealth.medalliesdirect.net

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1023096278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3238",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022413238",
            "telephone_number": "866-689-8862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 SUMMIT AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062853",
            "telephone_number": "401-793-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUROCK",
        "first_name": "JEFFREY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-07",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "RI",
            "license": "MD11229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS RI",
            "identifier": "27982-4",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECHIP",
            "identifier": "412095",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7056846",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.