Keith C. Burgess, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C01300 Issued in MD

Practice address

5601 Loch Raven Blvd
Baltimore, MD 21239-2905

Phone

(410) 532-4040

Fax

(410) 532-4962

NPI assigned

Jun 4, 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

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/7494/brand/1/csg/1/fhir/r4

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.

• Emergency Physicians SPPS

  • Emergency Medicine Physician
  • Baltimore, MD
  • NPI 1760885958
  Medicare reassignment
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bowie, MD
  • NPI 1093130924

  DC

  Medicare reassignment
• St. Paul Place Specialists, Inc.

  • Orthopaedic Foot and Ankle Surgery Physician
  • Baltimore, MD
  • NPI 1871549196
  Medicare reassignment
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Upper Marlboro, MD
  • NPI 1194195008
  NPD
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bel Air, MD
  • NPI 1649089418
  NPD
• St Paul Place Specialists Inc

  • Diagnostic Radiology Physician
  • Baltimore, MD
  • NPI 1497707681
  NPD
• Atlantic Physician Services of Maryland, PC

  • Physician Assistant
  • Baltimore, MD
  • NPI 1174632376
  NPD (past)
• MNR Industries LLC

  • Urgent Care Clinic/Center
  • Mount Airy, MD
  • NPI 1073963146
  NPD (past)
• Nephrology Center of Maryland, PA

  • Nephrology Physician
  • Baltimore, MD
  • NPI 1518932862
  NPD (past)
• Sheppard Pratt Physicians, P.a.

  • Psychiatry Physician
  • Baltimore, MD
  • NPI 1518990712
  NPD (past)

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1558309062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S EVERGREEN AVE",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080962739",
            "telephone_number": "856-686-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 LOCH RAVEN BLVD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212392905",
            "telephone_number": "410-532-4040",
            "fax_number": "410-532-4962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "KEITH",
        "middle_name": "C.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-04",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C01300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antoinette Burgess
• Autumn Burgess
• Brittany Michelle Burgess
• Christopher Burgess
• Janell Leslie Burgess, PA-C
• Reginald David Burgess, MS, LCPC, LCADC
• Thomas M Burggman, LCPC
• Anne Burghardt
• Bianca O Burgos
• Rachel Burgunder

• Physician Assistant in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.