Burgundy Prime Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

BURGUNDY PRIME INC

Practice address

430 Waymont CT Ste 100
Lake Mary, FL 32746-6745

Phone

(407) 878-0022

Fax

(407) 369-4267

NPI assigned

Nov 14, 2018

Organization subpart

No

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

Authorized official

Name

Abid Malik, MDNPI 1922122035

Title

President

Phone

(407) 777-8084

Specialties & licenses 7

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Abid Malik, M.D.

  • Psychiatry Physician
  • Longwood, FL
  • NPI 1922122035
  Medicare reassignment Care Compare group NPD Authorized official
• Amber Grimm, PA-C

  • Physician Assistant
  • Lake Mary, FL
  • NPI 1609414143
  Medicare reassignment Care Compare group
• Tiffany Dyann Jones, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Lake Mary, FL
  • NPI 1356991848
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1542153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542153600000",
    "number": "1720557150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 WAYMONT CT STE 100",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327466745",
            "telephone_number": "407-878-0022",
            "fax_number": "407-369-4267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 WAYMONT CT STE 100",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327466745",
            "telephone_number": "407-878-0022",
            "fax_number": "407-369-4267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURGUNDY PRIME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-14",
        "last_updated": "2018-11-14",
        "status": "A",
        "authorized_official_last_name": "MALIK",
        "authorized_official_first_name": "ABID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-777-8084",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084B0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0015X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Bumgarner
• Meagan Ann Burgess, APRN, FNP-BC
• Vincenzo Burgess
• Jo-Ellen K Burgett, PT
• Maria Fernanda Burgos-Frias
• Marley Alexandra Burke
• Thomas C. Burkley, DMD
• Keisha Dauphin Burrington, COTA/L
• Mya Burrowes
• Kayleigh Gisele Bush French

• Psychiatry Physician in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.