Active NPI
Jeanine Linehan-Burack, P.A.-C.
- Surgical Physician Assistant
- Augusta, GA
National Provider Identifier
1336108141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 004463
- Practice address
- 3675 J Dewey Gray Cir Ste 300
Augusta, GA 30909-1868 - Phone
- (706) 863-9595
- Fax
- (706) 868-8375
- NPI assigned
- Mar 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 9
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | |||
| Surgical Physician Assistant | 363AS0400X | PA9111128 | FL | |
| Surgical Physician Assistant | 363AS0400X | PA-1741 | ID | |
| Surgical Physician Assistant | 363AS0400X | PA13075 | TX | |
| Surgical Physician Assistant | 363AS0400X | 0110007257 | VA | |
| Surgical Physician Assistant | 363AS0400X | PA0000004410 | TN | |
| Surgical Physician Assistant | 363AS0400X | 0010-10111 | NC | |
| Surgical Physician Assistant | 363AS0400X | PA1200 | SC | |
| Surgical Physician Assistant | 363AS0400X | 004463 | GA | Primary |
Addresses
Primary practice location
3675 J Dewey Gray Cir Ste 300
Augusta, GA 30909-1868
Mailing address
PO Box 3726
Augusta, GA 30914-3726
Phone (706) 863-9595
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 519646861A | Medicaid | GA | |
| 0282PA | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4410 | TN | MD | Professional Counselor |
| 007339 | NY | MD | Acupuncturist |
| 004463 | GA | MD | Physical Therapist |
| 1200 | SC | MD | Physical Therapist |
| PA9111128 | FL | MD | Surgical Physician Assistant |
| PA-1741 | ID | MD | Surgical Physician Assistant |
| 0010-10111 | NC | MD | Surgical Physician Assistant |
| PA1200 | SC | MD | Surgical Physician Assistant |
| PA0000004410 | TN | MD | Surgical Physician Assistant |
| PA13075 | TX | MD | Surgical Physician Assistant |
| 0110007257 | VA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burn and Reconstructive Centers of Virginia, PLLC | Past | Accepting new patients |
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.
-
- Specialist
- Richmond, VA
- NPI 1194346734
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654214400000",
"number": "1336108141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3726",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309143726",
"telephone_number": "706-863-9595",
"fax_number": "706-868-8375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3675 J DEWEY GRAY CIR STE 300",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309091868",
"telephone_number": "706-863-9595",
"fax_number": "706-868-8375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LINEHAN-BURACK",
"first_name": "JEANINE",
"credential": "P.A.-C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-21",
"last_updated": "2022-06-03",
"certification_date": "2022-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": null,
"license": null,
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "FL",
"license": "PA9111128",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "ID",
"license": "PA-1741",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "TX",
"license": "PA13075",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "VA",
"license": "0110007257",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "TN",
"license": "PA0000004410",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NC",
"license": "0010-10111",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "SC",
"license": "PA1200",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "GA",
"license": "004463",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "519646861A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0282PA",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.