Edra Burris, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601009573 Issued in MI

Practice address

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746

Phone

(616) 363-7272

NPI assigned

Jul 30, 2020

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

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Imaging Associates of Indiana PCGroup PAC ID 1254503345, 293 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Franciscan Health Lafayette Hospital, Lafayette, IN, CCN 150109
• Franciscan Health Rensselaer, Inc Hospital, Rensselaer, IN, CCN 151324

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: eburris143264@direct.covenanthealthcare.com

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.

• Imaging Associates of Indiana, PC

  • Diagnostic Radiology Physician
  • Indianapolis, IN
  • NPI 1699072611
  Medicare reassignment Care Compare group

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

• Franciscan Health Lafayette

  • General Acute Care Hospital
  • Lafayette, IN
  • NPI 1356435341
  Care Compare affiliation
• Franciscan Health Rensselaer, Inc.

  • Critical Access Hospital
  • Rensselaer, IN
  • NPI 1932589173
  Care Compare affiliation

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673308800000",
    "number": "1215546791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7272"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1606 N 7th St",
            "address_purpose": "LOCATION",
            "city": "Terre Haute",
            "state": "IN",
            "postal_code": "478042706",
            "country_code": "US",
            "telephone_number": "812-238-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURRIS",
        "first_name": "EDRA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-30",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "243U00000X",
            "taxonomy_group": "",
            "desc": "Radiology Practitioner Assistant",
            "state": "MI",
            "license": "5601009573",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601009573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tessa Nicole Burrel, RD
• Joy R Burrell, MD
• Vita Burrell
• Carenda Burress
• Rachel Anne Burress
• Landon Daniel Burris, DC
• Karen Roberts Burritt, RN, FNP-BC
• Amanda Jo Burrows
• Autumn Marie Burrows
• Breanna Burrows, BS

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; 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.
• 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.