Active NPI
Stacey R Burge, LISW-SUPV
- Clinical Social Worker
- Cincinnati, OH
National Provider Identifier
1124250485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I.0009345-SUPV
- Practice address
- 2747 Losantiville Ave
Cincinnati, OH 45213-1265 - Phone
- (513) 633-8451
- NPI assigned
- Aug 19, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I.0009345-SUPV | OH | Primary |
Addresses
Primary practice location
2747 Losantiville Ave
Cincinnati, OH 45213-1265
Mailing address
2747 Losantiville Ave
Cincinnati, OH 45213-1265
Phone (513) 633-8451
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I.0009345-SUPV | OH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721779200000",
"number": "1124250485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2747 LOSANTIVILLE AVE",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452131265",
"telephone_number": "513-633-8451",
"fax_number": "513-896-5682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2747 LOSANTIVILLE AVE",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452131265",
"telephone_number": "513-633-8451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGE",
"first_name": "STACEY",
"middle_name": "R",
"credential": "LISW-SUPV",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-19",
"last_updated": "2024-07-24",
"certification_date": "2024-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I.0009345-SUPV",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.