Sara Burcham, PA-C
Individual provider Active NPI Medical Physician Assistant · Aztec, NM
NPI 1700106218 · NPPES record last updated Jun 25, 2019
Key facts
- NPI
- 1700106218
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA2018-0040 (NM)
- Practice address
- 604 S Rio Grande Ave
Aztec, NM 87410-2260 - Phone
- (505) 334-2664
- Fax
- (505) 334-7759
- NPI assigned
- Jun 7, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CO, ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181231001904 | CO | Practitioner - Physician Assistant | 1850690322 | Reassigns benefits to 1 organization |
| I20250806001535 | ID | Practitioner - Physician Assistant | 1850690322 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA06228 | TX | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Rehab Consultants PLLC | Current |
Accepting new patients |
Locations
1033 W Quinn Rd
Pocatello, ID 83202
Phone (208) 233-4800
415 W Golf Rd
Ste 26
Arlington Hts, IL 60005
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA06228 | TX | |
| Medical Physician Assistant | 363AM0700X | PA.0005385 | CO | |
| Medical Physician Assistant | 363AM0700X | PA2018-0040 | NM | Yes |
Addresses
Primary practice location
604 S Rio Grande Ave
Aztec, NM 87410-2260
Mailing address
2577 Main Ave
Durango, CO 81301-5919
Phone (970) 247-8382
Other practice location 1
2577 Main Ave
Durango, CO 81301-5919
Phone (970) 247-8382
Other providers in Aztec, NM
- Julie Bisbee
- Racine Bitsoi
- Lance H Black
- Sylvia Bowen
- Tori Lynn Brown
- Cedric Butler
- Amber Button
- Edward Campos
- Sarah Michelle Canion
- Sharon J Carpenter
All providers in Aztec, NM · Medical Physician Assistant in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2019. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.