Michael Keith Burnside, LPC, LADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2650 Issued in OK

Practice address

100 W 7TH St Ste 102
Okmulgee, OK 74447-5007

Phone

(918) 758-1910

Fax

(918) 756-1270

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• East Central Oklahoma Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Wetumka, OK
  • NPI 1316196546

  OK

  Medicare reassignment NPD
• East Central Oklahoma Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Wewoka, OK
  • NPI 1093184145
  NPD
• East Central Oklahoma Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Henryetta, OK
  • NPI 1639636657
  NPD
• Creek Nation Health Systems

  • Clinic/Center
  • Okmulgee, OK
  • NPI 1588672208
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236902400000",
    "number": "1194739334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 S 5TH ST",
            "city": "MORRIS",
            "state": "OK",
            "postal_code": "744452224",
            "telephone_number": "918-733-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W 7TH ST STE 102",
            "city": "OKMULGEE",
            "state": "OK",
            "postal_code": "744475007",
            "telephone_number": "918-758-1910",
            "fax_number": "918-756-1270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNSIDE",
        "first_name": "MICHAEL",
        "middle_name": "KEITH",
        "credential": "LPC, LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2009-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OK",
            "license": "553",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "2650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "300522336",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Shane Bruce, CRNA
• Ashley Jordan Bruner
• William Thomas Bryant, PH.D.
• Franchelle Burkhalter, RN
• Jamie Lynne Burney, LCSW
• Nicholas Busby, DDS
• Portia Lynn Butler
• Kylia Byassee
• Marquise Elzie Calhoun Jr.
• Braden Callister, DMD

• All providers in Okmulgee, OK
• Professional Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; 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.

Verify at the official NPI Registry.