Ellinor R Burke, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY003747 Issued in GA

Practice address

1201 Shadowlawn Dr Ste 101
Saint Marys, GA 31558-4074

Phone

(912) 744-0993

Fax

(912) 744-0993

NPI assigned

Jun 30, 2005

Last updated

Jul 1, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  GA, Psychologist

  Medicare reassignment NPD

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1821095399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5099",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315585099",
            "telephone_number": "912-882-3662",
            "fax_number": "912-882-7720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SHADOWLAWN DR STE 101",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315584074",
            "telephone_number": "912-744-0993",
            "fax_number": "912-744-0993"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10545 Colerain Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Marys",
            "state": "GA",
            "postal_code": "315583720",
            "country_code": "US",
            "telephone_number": "912-882-3662",
            "fax_number": "912-882-7720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURKE",
        "first_name": "ELLINOR",
        "middle_name": "R",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-30",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "PSY003747",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "35SI00313400",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY003747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6248306",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dale F Brown, M.D.
• Kaylee Susanne Brown, MD
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• Tyler Bunkley
• Lance Burk, DPT
• Stehanie Butler
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• Ashley Cabrera
• Jordan O'Banion Caglayan, AA
• Jaycee Cain, RN

• Psychologist in Saint Marys, GA
• Providers in Saint Marys, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.