Active NPI
Brian Burgess
- Allergy & Immunology Physician
- Wyoming, MI
National Provider Identifier
1326211129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- 07MC14
- Practice address
- 2433 Byron Center Ave SW
203
Wyoming, MI 49519-2196 - Phone
- (616) 819-9808
- NPI assigned
- Apr 12, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | 07MC14 | NJ | Primary |
Addresses
Primary practice location
2433 Byron Center Ave SW
203
Wyoming, MI 49519-2196
Mailing address
2433 Byron Center Ave SW
203
Wyoming, MI 49519-2196
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10114 | Other | MI | CMS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07MC14 | NJ | MD | Allergy & Immunology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207958400000",
"number": "1326211129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2433 BYRON CENTER AVE SW",
"address_2": "203",
"city": "WYOMING",
"state": "MI",
"postal_code": "495192196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2433 BYRON CENTER AVE SW",
"address_2": "203",
"city": "WYOMING",
"state": "MI",
"postal_code": "495192196",
"telephone_number": "616-819-9808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESS",
"first_name": "BRIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-12",
"last_updated": "2008-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "NJ",
"license": "07MC14",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CMS",
"identifier": "10114",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wyoming, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.