Kenneth David Burgess, M. D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

32655 Issued in NC

Practice address

3845 South New Hope Road
Gastonia, NC 28056

Phone

(704) 824-9119

Fax

(704) 824-2401

NPI assigned

Jan 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Caromont Medical Group Inc

  • Family Medicine Physician
  • Gastonia, NC
  • NPI 1356314272
  Medicare reassignment NPD
• Gaston Family Medicine, P. a.

  • Family Medicine Physician
  • Gastonia, NC
  • NPI 1992974042
  NPD Authorized official
• Caromont Medical Group Inc

  • Family Medicine Physician
  • Cherryville, NC
  • NPI 1124207725
  NPD
• Caromont Medical Group Inc

  • Family Medicine Physician
  • Stanley, NC
  • NPI 1972301380
  NPD

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215993600000",
    "number": "1538147376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551178",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280551178",
            "telephone_number": "704-824-9119",
            "fax_number": "704-824-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3845 SOUTH NEW HOPE ROAD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "28056",
            "telephone_number": "704-824-9119",
            "fax_number": "704-824-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "KENNETH",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2008-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "32655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "19982",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN#",
            "identifier": "205144C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "P00297412",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8919982",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bailey Bullock, OTD, OTR/L
• Pradip B Bulsara
• Jill Lynn Bumgardner, LCSW
• Jeffrey Todd Bunning, MD
• John Burger, D.O.
• Stephen B Burgess, M.D.
• Jeremy Burke
• Yarkeisha Burks
• Dylan Scott Burleson, PT, DPT, ATC
• Christine L Burns, WHNP

• Family Medicine Physician in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.