Individual provider Active NPI

Jacques Nicholas Burress

  • Nurse Practitioner
  • Edgewood, KY
National Provider Identifier
1255906392
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3016302 Issued in KY
Practice address
1 Medical Village Dr
Edgewood, KY 41017-3403
Phone
(859) 757-2927
Fax
(859) 341-0203
NPI assigned
May 21, 2021
Last updated
Mar 26, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3016302 KY Primary
Nurse Practitioner 363L00000X 71014904A IN
Acute Care Nurse Practitioner 363LA2100X 3016302 KY

Addresses

Primary practice location

1 Medical Village Dr
Edgewood, KY 41017-3403

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 344-5555

Other practice location 1

830 Thomas More Pkwy
Fort Mitchell, KY 41017-5102
Phone (707) 344-4983

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210817002972 KY Practitioner - Nurse Practitioner 0941605778 Reassigns benefits to 1 organization
I20240418000133 IN Practitioner - Nurse Practitioner 0941605778 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, shared by 11 NPIs, 803 clinicians

Practice addresses (Care Compare)

1 Medical Village Dr
Edgewood, KY 41017-3403
Phone (859) 301-5901

600 Wilson Creek Rd
Lawrenceburg, IN 47025-2751
Phone (812) 496-8771

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71014904AINMDNurse Practitioner
3016302KYMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc. CurrentSince May 29, 2023 Accepting new patients
Summit Medical Group, Inc Nurse Practitioner Current Accepting new patients
Summit Medical Group, Inc Nurse Practitioner CurrentSince May 29, 2023 Accepting new patients
St Elizabeth Medical Center, Inc Past Accepting new patients

Locations

204 Bridgeway St
Aurora, IN 47001
Phone (812) 926-3133

600 Wilson Creek Rd
Lawrenceburg, IN 47025
Phone (812) 532-2700

1500 James Simpson Jr Way
Ste 301
Covington, KY 41011
Phone (859) 344-5517

651 Centre View Blvd
Crestview Hills, KY 41017
Phone (859) 341-6660

1 Medical Village Dr
Edgewood, KY 41017
Phone (859) 301-2000

7370 Turfway Rd
Ste 150
Florence, KY 41042
Phone (859) 212-4450

830 Thomas More Pkwy
Fort Mitchell, KY 41017
Phone (859) 301-8686

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1255906392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-344-5555",
            "fax_number": "859-344-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL VILLAGE DR",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173403",
            "telephone_number": "859-757-2927",
            "fax_number": "859-341-0203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "830 Thomas More Pkwy",
            "address_purpose": "LOCATION",
            "city": "Fort Mitchell",
            "state": "KY",
            "postal_code": "410175102",
            "country_code": "US",
            "telephone_number": "707-344-4983",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURRESS",
        "first_name": "JACQUES",
        "middle_name": "NICHOLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-21",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3016302",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71014904A",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "KY",
            "license": "3016302",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.