Active NPI
JD Burgess
- Athletic Trainer
- Goodyear, AZ
National Provider Identifier
1326607474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0193
- Practice address
- 13635 W la Reata Ave
Goodyear, AZ 85395-2243 - Phone
- (623) 670-4930
- NPI assigned
- Jun 12, 2019
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0193 | AZ | Primary |
Addresses
Primary practice location
13635 W la Reata Ave
Goodyear, AZ 85395-2243
Mailing address
13635 W la Reata Ave
Goodyear, AZ 85395-2243
Phone (623) 670-4930
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 |
|---|---|---|---|
| 0193 | AZ | MD | Hand Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560297600000",
"number": "1326607474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13635 W LA REATA AVE",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853952243",
"telephone_number": "623-670-4930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13635 W LA REATA AVE",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853952243",
"telephone_number": "623-670-4930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESS",
"first_name": "JD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-12",
"last_updated": "2019-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AZ",
"license": "0193",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.