Mark Harold Burge, PH.D.
Individual provider Active NPI Clinical Psychologist · Birmingham, AL
NPI 1366488710 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1366488710
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 905 (AL)
- Practice address
- 2872 Acton Rd
Birmingham, AL 35243-2502 - Phone
- (205) 967-3660
- Fax
- (205) 967-3664
- NPI assigned
- Jun 22, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
2 Riverchase Office Plaza
Suite 115
Birmingham, AL 35244-2810
2 Riverchase Office PLZ
Suite 115
Birmingham, AL 35244-2810
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070518000559 | AL | Practitioner - Clinical Psychologist | 8123125523 | Practice locations: Hoover, AL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 905 | AL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burge Psychological Services | Current |
Accepting new patients | |
| Samaritan Counseling Center | Clinical | Past | Accepting new patients |
Locations
2 Riverchase Office Plz
Ste 115
Hoover, AL 35244
Phone (205) 403-0955
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 905 | AL | Yes |
| Clinical Psychologist | 103TC0700X | 1394 | KY |
Addresses
Primary practice location
2872 Acton Rd
Birmingham, AL 35243-2502
Mailing address
2872 Acton Rd
Birmingham, AL 35243-2502
Phone (205) 967-3660
Other providers in Birmingham, AL
- Jayne Ellen Burford
- Meghan Burford
- Frances Stafford Burgan
- Ian Ladd Burge
- Kaitlin Gail Burge
- Sonthe Bokas Burge
- Sophia E. Burge
- Stephen K Burge
- Eva Burgess
- Kathryn Simpson Burgess
All providers in Birmingham, AL · Clinical Psychologist in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.