Emily Jane Burgoon, D.O.
Individual provider Active NPI Neuromusculoskeletal Medicine & OMM Physician · Sedona, AZ
NPI 1174870174 · NPPES record last updated Nov 11, 2015
Key facts
- NPI
- 1174870174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neuromusculoskeletal Medicine & OMM Physician 204D00000X
- License
- 2010021895 (MO)
- Practice address
- 45 Castle Rock Rd 2a
Sedona, AZ 86351-8806 - Phone
- (540) 798-5655
- NPI assigned
- Aug 8, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
- Opted out of Medicare
- Yes, effective Nov 27, 2023 through Nov 27, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2010021895 | MO | MD | Neuromusculoskeletal Medicine & OMM Physician |
| 006216 | AZ | MD | Certified Respiratory Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ketamine Psycholytic Therapy LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuromusculoskeletal Medicine & OMM Physician | 204D00000X | 2010021895 | MO | Yes |
Addresses
Primary practice location
45 Castle Rock Rd 2a
Sedona, AZ 86351-8806
Mailing address
45 Castle Rock Rd 2a
Sedona, AZ 86351-8806
Phone (540) 798-5655
Other providers in Sedona, AZ
- Ahna E. Bridenbaugh
- Liza Brockway
- Gerald S Bronstein
- Michael Brown
- Lou Ann Bruck
- Barbara Cummings Burt
- Edward M Byers
- Joanne Cacciatore
- Glenn Cain
- Melissa Camacho
All providers in Sedona, AZ · Neuromusculoskeletal Medicine & OMM Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2015. 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).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.