Margaret Chelsea Ann Burris, APRN-CNP
Individual provider Active NPI Nurse Practitioner · Dix, IL
NPI 1093395022 · NPPES record last updated Apr 13, 2021
Key facts
- NPI
- 1093395022
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 209.022962 (IL)
- Practice address
- 1 Warren Way
Dix, IL 62830-1455 - Phone
- (618) 816-2709
- NPI assigned
- Apr 13, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Salem Township Hospital
Southern Illinois Heart and Vascular Center PC
Practice addresses (Care Compare)
1201 Ricker Rd
Salem, IL 62881-4263
Phone 61854831948188
1321 W Whittaker St
STH Family Health Care Center
Salem, IL 62881-2013
Phone 61854831948188
4115 S Water Tower PL
Mount Vernon, IL 62864-6293
Phone (618) 204-5462
Hospital & facility affiliations
- Good Samaritan Regional HLTH Center
- SSM Health St Mary'S Hospital -Centralia
- Salem Township Hospital
- Herrin Hospital
- Deaconess Illinois Crossroads
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220615002712 | IL | Practitioner - Nurse Practitioner | 1850770215 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.022962 | IL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Salem Township Hospital | Current |
Accepting new patients | |
| Southern Illinois Heart and Vascular Center, PC | Current |
Accepting new patients | |
| Salem Township Hospital | Current |
Accepting new patients | |
| Crossroads Physician Corporation | Past |
Accepting new patients | |
| Salem Township Hospital | Past | Accepting new patients |
Locations
4115 S Water Tower Pl
Mount Vernon, IL 62864
Phone (618) 204-5462
1201 Ricker Rd
Salem, IL 62881
Phone (618) 548-3194
1321 W Whittaker St
Salem, IL 62881
Phone (618) 548-0200
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JBDGCA
- https://fhir4.healow.com/fhir/r4/JBDGCA/Endpoint/JBDGCA
- mwilliams83966@direct-ehr-ssmhc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209.022962 | IL | Yes |
Addresses
Primary practice location
1 Warren Way
Dix, IL 62830-1455
Mailing address
1 Warren Way
Dix, IL 62830-1455
Phone (618) 816-2709
Other providers in Dix, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 13, 2021. 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.