Chanele M Burgun, MD
Individual provider Active NPI Family Medicine Physician · Fayetteville, NY
NPI 1619954823 · NPPES record last updated Oct 8, 2015
Key facts
- NPI
- 1619954823
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 217557 (NY)
- Practice address
- 212 Highbridge St C
Fayetteville, NY 13066-1981 - Phone
- (315) 637-0477
- Fax
- (315) 637-0559
- NPI assigned
- Dec 29, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Howard University College of Medicine, 1997
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Select PT, OT and SLP Rehabilitation Ny, PLLC
Errol S McKenzie MD PLLC
Practice addresses (Care Compare)
125 Harry Howard Ave
Hudson, NY 12534-1601
Phone (800) 479-7695
212 Highbridge St
Suite C
Fayetteville, NY 13066-1981
Phone (315) 637-0477
Hospital & facility affiliations
- Samaritan Medical Center
- University Hospital S U N Y Health Science Center
- Oneida Health Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060207000015 | NY | Practitioner - Family Practice | 0042225435 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Errol S McKenzie MD PLLC | Family Medicine | Current |
Accepting new patients |
| Genesee Valley Group Health Association | Past | Accepting new patients |
Locations
212 Highbridge St
Ste C
Fayetteville, NY 13066
Phone (315) 637-0477
Interoperability endpoints
- chanele.burgun.1@8712.direct.athenahealth.com
- https://api.platform.athenahealth.com/8712/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 217557 | NY | Yes |
Addresses
Primary practice location
212 Highbridge St C
Fayetteville, NY 13066-1981
Mailing address
212 Highbridge St C
Fayetteville, NY 13066-1981
Phone (315) 637-0477
Other providers in Fayetteville, NY
- Jenaye Karin Broe
- Dana Rae Brompton
- Vadjista Broumand
- Edith P Brown
- Joseph Bulone
- Jessica A Burt
- Cornelia Maria Buur
- Joseph L Byrne
- Michael F Cadin
- Robert Cady
All providers in Fayetteville, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.