NPIMap

Individual provider Active NPI

Edward Burke, M.D.

  • Internal Medicine Physician
  • Fredericktown, MO
National Provider Identifier
1306885157
Registry record updated Aug 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036099747 Issued in IL
Practice address
735 W Main St
Fredericktown, MO 63645-1113
Phone
(573) 783-8875
Fax
(573) 783-8890
NPI assigned
Jun 6, 2006
Last updated
Aug 16, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2010

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2010023551 MO
Internal Medicine Physician 207R00000X 036099747 IL Primary
General Practice Physician 208D00000X 2010023551 MO

Addresses

Primary practice location

735 W Main St
Fredericktown, MO 63645-1113

Mailing address

735 W Main St
Fredericktown, MO 63645-1113
Phone (573) 783-8875

Other identifiers 2

IdentifierTypeStateIssuer
597560408MedicaidMO
268942OtherMEDICARE RHC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20160127002357 MO Practitioner - Internal Medicine 1355234956 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

735 W Main St
Fredericktown, MO 63645-1113
Phone (573) 783-8875

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
67.5 of 100Reported as group
Quality
53.06
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2010023551MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Care Associates, Inc Family Medicine CurrentSince Dec 22, 2015 Accepting new patients
Community Health Care Associates, Inc Family Medicine CurrentSince Dec 22, 2015 Accepting new patients
The Baptist Home Past Accepting new patients
Potosi Manor, Inc. Past Accepting new patients
Madison Medical Center Stockhoff Memorial Nursing Home Past Accepting new patients
Safe Harbor Hospice, LLC Family Medicine PastSince Feb 17, 2023 Accepting new patients
Greenville Health Care Center, L.L.C. Past Accepting new patients
Medical Specialists LTD Family Medicine Past Accepting new patients
N & R of Fredericktown, Inc. Past Accepting new patients
The Baptist Home Past Accepting new patients
NHC Healthcare-Desloge LLC Past Accepting new patients
Country Meadows Nursing & Rehab LLC Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Locations

735 W Main St
Fredericktown, MO 63645
Phone (573) 747-9703

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Professional Health ServicesDesloge, MO, CCN 265158 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 13, 2018
Nov 13, 2018
Baptist Homes of Arcadia ValleyIronton, MO, CCN 265891 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
Nov 12, 2025
Legacy Operating Company, LLCFredericktown, MO, CCN 261586 Hospice Contracted Managing Employee Feb 17, 2023

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281916800000",
    "number": "1306885157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 W MAIN ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451113",
            "telephone_number": "573-783-8875",
            "fax_number": "573-783-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 W MAIN ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451113",
            "telephone_number": "573-783-8875",
            "fax_number": "573-783-8890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKE",
        "first_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2010-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2010023551",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036099747",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "2010023551",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "597560408",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RHC",
            "identifier": "268942",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericktown, MO

Sources for this page

Verify at the official NPI Registry.