Individual provider Active NPI

Buirge Sullivan Jones, QMHP

  • Mental Health Counselor
  • Roseburg, OR
National Provider Identifier
1619632791
Registry record updated Nov 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
548 SE Jackson St
Roseburg, OR 97470-4983
Phone
(541) 440-3532
NPI assigned
Nov 3, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

548 SE Jackson St
Roseburg, OR 97470-4983

Mailing address

PO Box 1121
Roseburg, OR 97470-0254
Phone (541) 672-2691

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2010
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

11 SW Brantley Dr
Winston, OR 97496-4526

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1619632791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1121",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974700254",
            "telephone_number": "541-672-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "548 SE JACKSON ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974704983",
            "telephone_number": "541-440-3532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "BUIRGE",
        "middle_name": "SULLIVAN",
        "credential": "QMHP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-03",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.