Emily Jane Burgoon, D.O.

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

2010021895 Issued in MO

Practice address

45 Castle Rock Rd 2a
Sedona, AZ 86351-8806

Phone

(540) 798-5655

NPI assigned

Aug 8, 2012

Last updated

Nov 11, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 27, 2023 through Nov 27, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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

• Ketamine Psycholytic Therapy LLC

  • Health Service Clinic/Center
  • Sedona, AZ
  • NPI 1972261824
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447200000000",
    "number": "1174870174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 CASTLE ROCK RD 2A",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863518806",
            "telephone_number": "540-798-5655",
            "fax_number": "928-852-0041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 CASTLE ROCK RD 2A",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863518806",
            "telephone_number": "540-798-5655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGOON",
        "first_name": "EMILY",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-08",
        "last_updated": "2015-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "MO",
            "license": "2010021895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ahna E. Bridenbaugh, L.AC.
• Liza Brockway, LCSW
• Gerald S Bronstein, M.D.
• Michael Brown, HAD
• Lou Ann Bruck, R.PH
• Barbara Cummings Burt, PSY.D.
• Edward M Byers, DDS
• Joanne Cacciatore, PHD
• Glenn Cain, RPH
• Melissa Camacho, L.AC.

• Neuromusculoskeletal Medicine & OMM Physician in Sedona, AZ
• Providers in Sedona, AZ by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.