Active NPI
Jon Michael Burroughs, LCSW
- Clinical Social Worker
- Raleigh, NC
National Provider Identifier
1619026366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C004134
- Practice address
- 5505 Creedmoor Rd Ste 100
Raleigh, NC 27612-6333 - Phone
- (919) 852-5352
- Fax
- (919) 933-1854
- NPI assigned
- Jan 10, 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C004134 | NC | Primary |
Addresses
Primary practice location
5505 Creedmoor Rd Ste 100
Raleigh, NC 27612-6333
Mailing address
4811 Fortunes Ridge Dr
Durham, NC 27713-9348
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6003440 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC, SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
600 Park Offices Dr
Suite 300
Durham, NC 27709
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolina Community Mental Health Centers, Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- Raleigh, NC
- NPI 1184859761
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220572800000",
"number": "1619026366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4811 FORTUNES RIDGE DR",
"city": "DURHAM",
"state": "NC",
"postal_code": "277139348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5505 CREEDMOOR RD STE 100",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276126333",
"telephone_number": "919-852-5352",
"fax_number": "919-933-1854"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURROUGHS",
"first_name": "JON",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2008-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C004134",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6003440",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.