Jessica Rose Burgess-Wise, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

674 Issued in MA

Practice address

40 Wright Street
Wing Memorial Hospital Griswold Center
Palmer, MA 01069

Phone

(413) 284-5285

Fax

(413) 284-5384

NPI assigned

Jul 11, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jessica Rose Burgess Former name

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2001

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376577528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 WRIGHT STREET",
            "city": "PALMER",
            "state": "MA",
            "postal_code": "01069",
            "telephone_number": "413-283-7651",
            "fax_number": "413-284-5117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 WRIGHT STREET",
            "address_2": "WING MEMORIAL HOSPITAL GRISWOLD CENTER",
            "city": "PALMER",
            "state": "MA",
            "postal_code": "01069",
            "telephone_number": "413-284-5285",
            "fax_number": "413-284-5384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS-WISE",
        "first_name": "JESSICA",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MA",
            "license": "674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "BURGESS",
            "middle_name": "ROSE",
            "credential": "LADC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stefan Boas, MD
• Jenna Brianne Booker, PA-C
• Glen Michael Bouchard, D.O.
• Barbara A Bready, LICSW
• Kristen Rose Briody, NP
• Taniesha L Burton
• Paula Calheno, R,N.
• Robert J Campbell, MD
• Canary Rehab
• Thomas R Canto, MD

• Addiction (Substance Use Disorder) Counselor in Palmer, MA
• Providers in Palmer, MA by specialty
• Addiction (Substance Use Disorder) Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.