Nicole Lynn Burgess, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501013985 Issued in MI

Practice address

183 Peace Blvd
Saint Joseph, MI 49085-9146

Phone

(269) 408-1636

Fax

(269) 429-6451

NPI assigned

Oct 22, 2007

Last updated

Jan 15, 2025By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southwest Michigan Center for Orthopaedic and Sports Medicine PGroup PAC ID 5890688444, 12 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southwest Michigan Center for Orthopaedic and Sports Medicine P

  • Specialist
  • Saint Joseph, MI
  • NPI 1104913094
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1194914648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "183 PEACE BLVD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859146",
            "telephone_number": "269-408-1636",
            "fax_number": "269-429-6451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "183 PEACE BLVD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859146",
            "telephone_number": "269-408-1636",
            "fax_number": "269-429-6451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "451 Health Pkwy",
            "address_purpose": "LOCATION",
            "city": "Paw Paw",
            "state": "MI",
            "postal_code": "490798242",
            "country_code": "US",
            "telephone_number": "269-657-1490",
            "fax_number": "269-657-1444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "53880 Carmichael Dr",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466351567",
            "country_code": "US",
            "telephone_number": "574-247-9441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "NICOLE",
        "middle_name": "LYNN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-22",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05009436A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501013985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200876240",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ather M Bukhari, MD
• Anneke Bulthuis, D.O.
• Alicia Bultsma, OD
• Erin Renee Burchett, DO
• James R Burczak, D.O.
• Cathleen A Burns, MA, CCC-A
• Kamelia Burrell-Fowler, FNP
• Michael James Burton, M.D.
• Becky Marie Bus, CNP
• Bridgette A Butler

• Physical Therapist in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.