Bradley D Burgess, M.A..
Individual provider Active NPI Professional Counselor · Society Hill, SC
NPI 1730480971 · NPPES record last updated Sep 13, 2017
Key facts
- NPI
- 1730480971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 6071 (SC)
- Practice address
- 737 S Main St
Society Hill, SC 29593-8972 - Phone
- (843) 378-4501
- Fax
- (843) 378-4209
- NPI assigned
- Nov 4, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 12
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Caresouth Carolina Inc.
Practice addresses (Care Compare)
1268 S 4TH St
Hartsville, SC 29550-0703
Phone (843) 332-3422
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240227002622 | SC | Practitioner - Mental Health Counselor | 1951619667 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6071 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Caresouth Carolina, Inc | Current |
Accepting new patients | |
| Caresouth Carolina, Inc. | Current | Accepting new patients |
Locations
545 Sumter Hwy
Bishopville, SC 29010
Phone (803) 484-5317
1268 S 4th St
Hartsville, SC 29550
Phone (843) 332-3422
737 S Main St
Society Hill, SC 29593
Phone (843) 378-3000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 6071 | SC | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 101YM0800X | 6071 | SC | |
| Professional Counselor | 101YP2500X | 6071 | SC | Yes |
Addresses
Primary practice location
737 S Main St
Society Hill, SC 29593-8972
Mailing address
PO Box 1090
Hartsville, SC 29551-1090
Phone (843) 857-0111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PC1532 | Medicaid | SC |
NPI Registry JSON
{
"created_epoch": "1288828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505260800000",
"number": "1730480971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1090",
"city": "HARTSVILLE",
"state": "SC",
"postal_code": "295511090",
"telephone_number": "843-857-0111",
"fax_number": "843-857-0206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "737 S MAIN ST",
"city": "SOCIETY HILL",
"state": "SC",
"postal_code": "295938972",
"telephone_number": "843-378-4501",
"fax_number": "843-378-4209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESS",
"first_name": "BRADLEY",
"middle_name": "D",
"credential": "M.A..",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-11-04",
"last_updated": "2017-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "SC",
"license": "6071",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "SC",
"license": "6071",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "SC",
"license": "6071",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PC1532",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Society Hill, SC
- Active SC Two, Inc.
- Sean G Boynes
- Levina Brown
- Caresouth Carolina Inc
- Caresouth Carolina Inc
- Caresouth Carolina, Inc
- Michael K Chandler
- Courtney Nicole Feagin
All providers in Society Hill, SC · Professional Counselor in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2017. 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.