NPIMap

Individual provider Active NPI

Shannon Marie Burgess, M.D.

  • Internal Medicine Physician
  • Greenville, SC
National Provider Identifier
1205198637
Registry record updated Mar 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
34857 Issued in SC
Practice address
1809 Wade Hampton Blvd
Suite 120
Greenville, SC 29609-4041
Phone
(864) 522-7000
Fax
(864) 241-9275
NPI assigned
Jun 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2024

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 34857 SC
Internal Medicine Physician 207R00000X 34857 SC Primary

Addresses

Primary practice location

1809 Wade Hampton Blvd
Suite 120
Greenville, SC 29609-4041

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8617

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sburgess5816@direct.ghs.myhfn.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20160908002081 SC Practitioner - Internal MedicinePractitioner - Pediatric Medicine 3375708886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of South Alabama College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1809 Wade Hampton Blvd
Suite 120
Greenville, SC 29609-4050
Phone (864) 522-5000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34857SCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Aug 28, 2016 Accepting new patients
Prisma Health University Medical Group CurrentSince Aug 28, 2016 Accepting new patients
Prisma Health University Medical Group Internal Medicine Current Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

701 Grove Rd
Greenville, SC 29605
Phone (864) 454-2030

1809 Wade Hampton Blvd
Ste 120
Greenville, SC 29609
Phone (864) 322-4665

100 Augusta St
Greenville, SC 29601
Phone (864) 455-2600

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

Interoperability endpoints

  • Direct secure messaging: sburgess5816@direct.ghs.myhfn.org

Organizations & group practices 3

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 54

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711152000000",
    "number": "1205198637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 WADE HAMPTON BLVD",
            "address_2": "SUITE 120",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296094041",
            "telephone_number": "864-522-7000",
            "fax_number": "864-241-9275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-12",
        "last_updated": "2024-03-23",
        "certification_date": "2024-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "34857",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "34857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sburgess5816@direct.ghs.myhfn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "sburgess5816@direct.ghs.myhfn.org",
            "address_1": "1809 Wade Hampton Blvd",
            "address_2": "Suite 120",
            "city": "Greenville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296094041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.