Cullen William Burke, MD
Individual provider Active NPI Psychiatry Physician · Baton Rouge, LA
NPI 1063778645 · NPPES record last updated Feb 9, 2022
Key facts
- NPI
- 1063778645
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 300785 (LA)
- Practice address
- 7777 Hennessy Blvd
Suite 6000
Baton Rouge, LA 70808-4300 - Phone
- (225) 765-8648
- Fax
- (225) 765-7754
- NPI assigned
- Apr 8, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Tulane University School of Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Our Lady of the Lake Physician Group LLC
Practice addresses (Care Compare)
5131 Odonovan Dr
Suite 300
Baton Rouge, LA 70808-4782
Phone (225) 765-7778
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160719002787 | LA | Practitioner - Psychiatry | 8426358615 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 300785 | LA | MD | Psychiatry Physician |
Practice roles (4 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wash-St Tammany Reg Medical Center | Current | Accepting new patients | |
| Our Lady of the Lake Physician Group LLC | Current |
Accepting new patients | |
| Our Lady of the Lake Physician Group LLC | Psychiatry | Current | Accepting new patients |
| Our Lady of the Lake Physician Group, LLC | Current |
Accepting new patients |
Locations
7777 Hennessy Blvd
Ste 701
Baton Rouge, LA 70808
Phone (225) 765-5864
5000 Hennessy Blvd
Baton Rouge, LA 70808
Phone (225) 765-4050
5131 Odonovan Dr
Ste 300
Baton Rouge, LA 70808
Phone (225) 374-0400
5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011
8080 Margaret Ann Ave
Baton Rouge, LA 70809
Phone (225) 765-4353
7777 Hennessy Blvd
Ste 6000
Baton Rouge, LA 70808
Phone (225) 765-8648
433 Plaza St
Rm 213
Bogalusa, LA 70427
Phone (985) 730-7209
433 Plaza St
Bogalusa, LA 70427
Phone (985) 730-6700
Networks
- LA PPO C-SNP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 300785 | LA | Yes |
Addresses
Primary practice location
7777 Hennessy Blvd
Suite 6000
Baton Rouge, LA 70808-4300
Mailing address
5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (225) 526-0006
Other practice location 1
433 Plaza St
Bogalusa, LA 70427-3729
Phone (985) 730-7152
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300785 | Other | LA | STATE LICENSE |
| 2199269 | Medicaid | LA |
Other providers in Baton Rouge, LA
- John B Burgess Jr.
- Robert Tanner Burgess
- Daniel M Burgin
- Harry A Burglass Jr.
- Catrina Aucoin Burke
- Emily Cecile Burke
- Robert Evans Burke
- Jode Burkett
- Laurie Prather Burkett
- Breah E Burkhalter
All providers in Baton Rouge, LA · Psychiatry Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.