Active NPI
Chad Burgess
- Endodontics
- Oceanside, CA
National Provider Identifier
1821173022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 48788
- Practice address
- 3601 Vista Way
Suite 202
Oceanside, CA 92056-4559 - Phone
- (760) 216-3600
- NPI assigned
- Oct 26, 2006
- Last updated
- Apr 25, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 48788 | CA | Primary |
Addresses
Primary practice location
3601 Vista Way
Suite 202
Oceanside, CA 92056-4559
Mailing address
780 Settlers CT
San Marcos, CA 92069-1961
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 2, 2015 through Dec 2, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48788 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303689600000",
"number": "1821173022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "780 SETTLERS CT",
"city": "SAN MARCOS",
"state": "CA",
"postal_code": "920691961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 VISTA WAY",
"address_2": "SUITE 202",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920564559",
"telephone_number": "760-216-3600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESS",
"first_name": "CHAD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2011-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "48788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oceanside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2011; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.