Individual provider Active NPI

William Thomas Burnett, M.D.

  • Emergency Medicine Physician
  • Greenville, SC
National Provider Identifier
1780787093
Registry record updated Jul 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0101237968 Issued in VA
Practice address
701 Grove Rd
Greenville, SC 29605
Phone
(864) 455-7000
NPI assigned
Sep 6, 2006
Last updated
Jul 10, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 21988 SC
Emergency Medicine Physician 207P00000X 0101237968 VA Primary

Addresses

Primary practice location

701 Grove Rd
Greenville, SC 29605

Mailing address

200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698

Other identifiers 3

IdentifierTypeStateIssuer
010151414MedicaidVA
3810002000MedicaidWV
010151392MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050623000599 VA Practitioner - Emergency Medicine 4587577515 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
21988SCMDEmergency Medicine Physician
0101237968VAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wildwood Emergency Group, LLC Emergency Medicine CurrentSince Jun 10, 2018 Accepting new patients
Lake Spring Emergency Group, LLC Emergency Medicine CurrentSince Jun 25, 2018 Accepting new patients
Kingsford Emergency Group, LLC Emergency Medicine CurrentSince Jun 26, 2018 Accepting new patients
Kingsford Physician Services, LLC CurrentSince Jul 1, 2018 Accepting new patients

Locations

200 Corporate Blvd
Lafayette, LA 70508

3700 S Main St
Blacksburg, VA 24060
Phone (540) 951-1111

2400 Lee Hwy N
Pulaski, VA 24301
Phone (540) 994-8100

2706 Ogden Rd
Roanoke, VA 24018
Phone (540) 970-8000

1900 Electric Rd
Salem, VA 24153
Phone (540) 772-3400

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1780787093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "29605",
            "telephone_number": "864-455-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNETT",
        "first_name": "WILLIAM",
        "middle_name": "THOMAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "21988",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101237968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010151414",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810002000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010151392",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.