Active NPI
Susan Mary Burkhart, M.D.
- Family Medicine Physician
- Versailles, MO
National Provider Identifier
1447257571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 104938
- Practice address
- 801 Kidwell Drive
St Mary'S Clinic
Versailles, MO 65084 - Phone
- (573) 378-5454
- Fax
- (573) 378-5055
- NPI assigned
- Jul 5, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 104938 | MO | |
| Family Medicine Physician | 207Q00000X | 104938 | MO | Primary |
Addresses
Primary practice location
801 Kidwell Drive
St Mary'S Clinic
Versailles, MO 65084
Mailing address
P.O. Box 1027
Jefferson City, MO 65102-1027
Phone (573) 761-7246
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33968017 | Other | MO | BCBS |
| 207903022 | Medicaid | MO | |
| 2007903022 | Medicaid | MO | |
| 853019 | Other | MO | FRIST HEALTH |
| 32329 | Other | MO | FAMILY HEALTH PARTNERS |
| 5487 | Other | MO | HEALTH CARE USA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Family Medicine | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348790400000",
"number": "1447257571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1027",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651021027",
"telephone_number": "573-761-7246",
"fax_number": "573-761-6947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 KIDWELL DRIVE",
"address_2": "ST MARY'S CLINIC",
"city": "VERSAILLES",
"state": "MO",
"postal_code": "65084",
"telephone_number": "573-378-5454",
"fax_number": "573-378-5055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURKHART",
"first_name": "SUSAN",
"middle_name": "MARY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-05",
"last_updated": "2012-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MO",
"license": "104938",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "104938",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "33968017",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "207903022",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2007903022",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FRIST HEALTH",
"identifier": "853019",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FAMILY HEALTH PARTNERS",
"identifier": "32329",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH CARE USA",
"identifier": "5487",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Versailles, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.