Active NPI
Stephan G Burgeson, MD
- Internal Medicine Physician
- Saint Paul, MN
National Provider Identifier
1346206208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 32841
- Practice address
- 777 Selby Ave
Saint Paul, MN 55104-6619 - Phone
- (651) 358-2425
- NPI assigned
- Apr 21, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 32841 | MN | Primary |
Addresses
Primary practice location
777 Selby Ave
Saint Paul, MN 55104-6619
Mailing address
777 Selby Ave
Saint Paul, MN 55104-6619
Phone (651) 358-2425
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Previously, effective Aug 9, 2018 through Aug 9, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32841 | MN | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620259200000",
"number": "1346206208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "777 SELBY AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551046619",
"telephone_number": "651-358-2425",
"fax_number": "651-419-6111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 SELBY AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551046619",
"telephone_number": "651-358-2425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESON",
"first_name": "STEPHAN",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-21",
"last_updated": "2021-05-06",
"certification_date": "2021-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MN",
"license": "32841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.