NPIMap

Individual provider Active NPI

Jacques Burgess, MD

  • Internal Medicine Physician
  • Traverse City, MI
National Provider Identifier
1174549802
Registry record updated Aug 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301070541 Issued in MI
Practice address
1105 Sixth St
Traverse City, MI 49684-2345
Phone
(231) 935-5000
Fax
(231) 346-6017
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301070541 MI
Internal Medicine Physician 207R00000X 4301070541 MI Primary

Addresses

Primary practice location

1105 Sixth St
Traverse City, MI 49684-2345

Mailing address

PO Box 27127
Lansing, MI 48909-7127
Phone (231) 346-6800

Other identifiers 2

IdentifierTypeStateIssuer
4234840MedicaidMI
4324722MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20090129000349 MI Practitioner - HospitalistPractitioner - Internal MedicinePractitioner - Pediatric Medicine 6103980560 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Pediatric Medicine
Education
Michigan State University College of Human Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand Traverse Physician Services PCGroup PAC ID 2466963806, 119 clinicians

Practice addresses (Care Compare)

1105 6TH St
Traverse City, MI 49684-2345
Phone (231) 935-5000

Hospital & facility affiliations

  • Munson Medical Center Hospital, Traverse City, MI, CCN 230097

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center Current Accepting new patients
Hospitalist Medicine Physicians of Michigan, PLLC Internal Medicine Current Accepting new patients
Sound Inpatient Physicians-Michigan, PLLC Internal Medicine Current Accepting new patients
Sound Inpatient Physicians - Michigan, PLLC Internal Medicine CurrentSince Jul 16, 2019 Accepting new patients
Hospitalist Medicine Physicians of Michigan PLLC Internal Medicine CurrentSince Jun 1, 2019 Accepting new patients
Sound Inpatient Physicians-Michigan PLLC Internal Medicine CurrentSince Jul 16, 2019 Accepting new patients
Grand Traverse Physician Services PC Internal Medicine CurrentSince Jul 1, 2025 Accepting new patients
Indigo Services, PLC Internal Medicine Past Accepting new patients
Munson Medical Center Past Accepting new patients
Munson Medical Center Past Accepting new patients
Mercy Hospital Grayling Past Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

400 Hobart St
Cadillac, MI 49601
Phone (231) 876-7200

224 Park Ave
Frankfort, MI 49635
Phone (231) 352-2200

1100 E Michigan Ave
Grayling, MI 49738
Phone (989) 348-0317

1 Atkinson Dr
Ludington, MI 49431
Phone (231) 843-2591

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

Organizations & group practices 12

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

Hospital & facility affiliations 1

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1174549802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27127",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489097127",
            "telephone_number": "231-346-6800",
            "fax_number": "231-346-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-935-5000",
            "fax_number": "231-346-6017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "JACQUES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301070541",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301070541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4234840",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4324722",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.