Active NPI
John Burke, PH.D
- Psychologist
- Appleton, WI
National Provider Identifier
1558381566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1407-057
- Practice address
- 820 E Grant St
Appleton, WI 54911-3483 - Phone
- (920) 831-5050
- NPI assigned
- Jul 20, 2006
- Last updated
- Jul 8, 2007
- 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 | 1407-057 | WI | Primary |
Addresses
Primary practice location
820 E Grant St
Appleton, WI 54911-3483
Mailing address
PO Box 8003
Appleton, WI 54912-8003
Phone (920) 996-3298
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39089200 | Medicaid | WI |
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 Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1407 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 1407-057 | WI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558381566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8003",
"city": "APPLETON",
"state": "WI",
"postal_code": "549128003",
"telephone_number": "920-996-3298",
"fax_number": "920-738-5787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 E GRANT ST",
"city": "APPLETON",
"state": "WI",
"postal_code": "549113483",
"telephone_number": "920-831-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURKE",
"first_name": "JOHN",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "1407-057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39089200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.