Individual provider Active NPI

Jennifer A Burgess, FNP-C

  • Family Nurse Practitioner
  • Portland, ME
National Provider Identifier
1316465636
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP171078 Issued in ME
Practice address
716 Stevens Ave
Portland, ME 04103-2656
Phone
(207) 221-4242
NPI assigned
Sep 7, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CNP171078 ME Primary
Registered Nurse 163W00000X RN61814 ME

Addresses

Primary practice location

716 Stevens Ave
Portland, ME 04103-2656

Mailing address

PO Box 10475
Portland, ME 04104-0475

Other practice location 1

11 Hills Beach Rd
Biddeford, ME 04005-9526
Phone (207) 602-2358

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20180209001114 ME Practitioner - Nurse Practitioner 9931469095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN61814MEMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth Current Accepting new patients
Mainehealth CurrentSince Jan 1, 2019 Accepting new patients
Mainehealth Family CurrentSince Jan 1, 2019 Accepting new patients

Locations

2 Springbrook Dr
Biddeford, ME 04005
Phone (207) 252-1500

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

78 Atlantic Pl
South Portland, ME 04106
Phone (207) 661-6654

Interoperability endpoints

  • Direct secure messaging: jburgess306854@direct.mmc.mainehealth.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.

NPI Registry JSON

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

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1316465636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10475",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041040475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 STEVENS AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032656",
            "telephone_number": "207-221-4242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 Hills Beach Rd",
            "address_purpose": "LOCATION",
            "city": "Biddeford",
            "state": "ME",
            "postal_code": "040059526",
            "country_code": "US",
            "telephone_number": "207-602-2358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "CNP171078",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ME",
            "license": "RN61814",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.