Individual provider Active NPI

Jeannette E. Burg

  • Clinic/Center
  • Humble, TX
National Provider Identifier
1790793859
Registry record updated Apr 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
261QR0400X Issued in TX
Practice address
9810 FM 1960 Bypass Rd W
# 190
Humble, TX 77338-3522
Phone
(281) 446-0371
Fax
(281) 446-4299
NPI assigned
Aug 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 100283 TX
Clinic/Center 261Q00000X 261QR0400X TX Primary

Addresses

Primary practice location

9810 FM 1960 Bypass Rd W
# 190
Humble, TX 77338-3522

Mailing address

1707 South Blvd
Houston, TX 77098-5419
Phone (713) 526-4997

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
261QR0400XTXMDPhysical Therapy Assistant
100283TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Jeannette E. Burg Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303344000000",
    "number": "1790793859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 SOUTH BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770985419",
            "telephone_number": "713-526-4997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9810 FM 1960 BYPASS RD W",
            "address_2": "# 190",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773383522",
            "telephone_number": "281-446-0371",
            "fax_number": "281-446-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURG",
        "first_name": "JEANNETTE",
        "middle_name": "E.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2011-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "100283",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "261QR0400X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Humble, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.