Individual provider Active NPI

Michael Burks, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Medford, OR
National Provider Identifier
1306274303
Registry record updated Jul 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
201708072NP Issued in OR
Practice address
19 Myrtle St
Medford, OR 97504-7337
Phone
(541) 773-3863
Fax
(541) 776-2892
NPI assigned
Oct 29, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 201708072NP OR Primary
Family Nurse Practitioner 363LF0000X 23793 CA

Addresses

Primary practice location

19 Myrtle St
Medford, OR 97504-7337

Mailing address

19 Myrtle St
Medford, OR 97504-7337
Phone (541) 773-3863

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20150309000043 OR Practitioner - Nurse Practitioner 1951627017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Paradigm Mental Health and Wellness LLCGroup PAC ID 2961808076, 3 clinicians

Practice addresses (Care Compare)

724 S Central Ave
Suite 101D
Medford, OR 97501-7808
Phone (541) 249-7724

Hospital & facility affiliations

  • Asante Rogue Regional Medical Center Hospital, Medford, OR, CCN 380018

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23793CAMDOccupational Therapist
201708072NPORMDPsychiatric/Mental Health Nurse Practitioner

Organizations & group practices 1

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 1

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": "1383004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1306274303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 MYRTLE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047337",
            "telephone_number": "541-773-3863",
            "fax_number": "541-776-2892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 MYRTLE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047337",
            "telephone_number": "541-773-3863",
            "fax_number": "541-776-2892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKS",
        "first_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-10-29",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201708072NP",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "23793",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.