Active NPI
Jacob Burmeister, PHD
- Psychologist
- Perrysburg, OH
National Provider Identifier
1467067744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- P.08070
- Practice address
- 1070 Commerce
Building 2, Suite 301
Perrysburg, OH 43551 - Phone
- (419) 931-3029
- NPI assigned
- Sep 13, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | P.08070 | OH | Primary |
Addresses
Primary practice location
1070 Commerce
Building 2, Suite 301
Perrysburg, OH 43551
Mailing address
1070 Commerce Dr Ste 301
Perrysburg, OH 43551-5236
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 12, 2022 through Jan 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P.08070 | OH | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599955200000",
"number": "1467067744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1070 COMMERCE DR STE 301",
"city": "PERRYSBURG",
"state": "OH",
"postal_code": "435515236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1070 COMMERCE",
"address_2": "BUILDING 2, SUITE 301",
"city": "PERRYSBURG",
"state": "OH",
"postal_code": "43551",
"telephone_number": "419-931-3029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURMEISTER",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-13",
"last_updated": "2020-09-13",
"certification_date": "2020-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OH",
"license": "P.08070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Perrysburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.