Active NPI
Brian Thomas Burgess, PSYD
- Clinical Psychologist
- Corona, CA
National Provider Identifier
1073861217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY31294
- Practice address
- 2292 Adrienne Dr
Corona, CA 92882-5113 - Phone
- (773) 318-2361
- NPI assigned
- Aug 20, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 180008239 | IL | |
| Clinical Psychologist | 103TC0700X | PSY31294 | CA | Primary |
Addresses
Primary practice location
2292 Adrienne Dr
Corona, CA 92882-5113
Mailing address
2292 Adrienne Dr
Corona, CA 92882-5113
Phone (773) 318-2361
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180008239 | IL | MD | Mental Health Counselor |
| PSY31294 | CA | MD | Clinical Psychologist |
| 31294 | CA | MD | Rehabilitation Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714089600000",
"number": "1073861217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2292 ADRIENNE DR",
"city": "CORONA",
"state": "CA",
"postal_code": "928825113",
"telephone_number": "773-318-2361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2292 ADRIENNE DR",
"city": "CORONA",
"state": "CA",
"postal_code": "928825113",
"telephone_number": "773-318-2361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESS",
"first_name": "BRIAN",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-20",
"last_updated": "2024-04-26",
"certification_date": "2024-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "180008239",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY31294",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.