NPIMap

Organization Active NPI

Renee Burdett, MD PC

  • Multi-Specialty Clinic/Center
  • Woodbridge, VA
National Provider Identifier
1760540967
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
RENEE BURDETT, MD PC
Practice address
13649 Office Place
Suite 102
Woodbridge, VA 22192
Phone
(703) 670-5738
Fax
(703) 670-8213
NPI assigned
Dec 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

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

Authorized official

Name
V Renee Burdett, MDNPI 1821168212
Title
Medical Director Ceo
Phone
(703) 670-5738

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavioral Neurology & Neuropsychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084B0040X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

13649 Office Place
Suite 102
Woodbridge, VA 22192

Mailing address

13649 Office Place
Suite 102
Woodbridge, VA 22192
Phone (703) 670-5738

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090623000572 VA Part B Supplier - Clinic/Group Practice 2264583764 Receives reassigned benefits from 6 practitioners
Practice locations: Woodbridge, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1760540967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13649 OFFICE PLACE",
            "address_2": "SUITE 102",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22192",
            "telephone_number": "703-670-5738",
            "fax_number": "703-670-8213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13649 OFFICE PLACE",
            "address_2": "SUITE 102",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22192",
            "telephone_number": "703-670-5738",
            "fax_number": "703-670-8213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEE BURDETT, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "BURDETT",
        "authorized_official_first_name": "V",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR CEO",
        "authorized_official_telephone_number": "703-670-5738",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; 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.