Individual provider Active NPI

Daisha Monea Burgess, LICSW

  • Clinical Social Worker
  • Madison, AL
National Provider Identifier
1801575519
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
5286C Issued in AL
Practice address
350 Sun Temple Dr
Madison, AL 35758-5919
Phone
(256) 975-4291
Fax
(256) 288-3334
NPI assigned
Jul 12, 2023
Last updated
Jul 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 5286C AL Primary

Addresses

Primary practice location

350 Sun Temple Dr
Madison, AL 35758-5919

Mailing address

600 Sun Temple Dr
Madison, AL 35758-8643
Phone (256) 975-4291

Other practice location 1

1800 Beverly Ave
Muscle Shoals, AL 35661-3255
Phone (256) 320-7475

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230803002142 AL Practitioner - Clinical Social Worker 7416318654 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Behavioral Health IncGroup PAC ID 7416194113, 109 clinicians

Practice addresses (Care Compare)

350 Sun Temple Dr
Madison, AL 35758-5919
Phone (256) 288-3333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5286CALMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Behavioral Health, Inc. Clinical CurrentSince Jul 17, 2023 Accepting new patients

Locations

350 Sun Temple Dr
Madison, AL 35758
Phone (256) 325-2627

600 Sun Temple Dr
Madison, AL 35758
Phone (256) 325-2627

1800 Beverly Ave
Muscle Shoals, AL 35661
Phone (256) 320-7475

25850 Main St
Ardmore, TN 38449
Phone (931) 427-4050

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, 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": "1689120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1801575519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SUN TEMPLE DR",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357588643",
            "telephone_number": "256-975-4291",
            "fax_number": "256-288-3334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 SUN TEMPLE DR",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357585919",
            "telephone_number": "256-975-4291",
            "fax_number": "256-288-3334"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Beverly Ave",
            "address_purpose": "LOCATION",
            "city": "Muscle Shoals",
            "state": "AL",
            "postal_code": "356613255",
            "country_code": "US",
            "telephone_number": "256-320-7475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "DAISHA",
        "middle_name": "MONEA",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-12",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "5286C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, AL

Sources for this page

Verify at the official NPI Registry.