NPIMap

Individual provider Active NPI

John P. Burge, MD

  • Surgery Physician
  • Lake Village, AR
National Provider Identifier
1851370753
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
C3006 Issued in AR
Practice address
2918 Louis Sessions Street
Lake Village, AR 71653
Phone
(870) 265-5343
Fax
(870) 265-5686
NPI assigned
Jan 10, 2006
Last updated
Sep 29, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X C3006 AR Primary

Addresses

Primary practice location

2918 Louis Sessions Street
Lake Village, AR 71653

Mailing address

2918 Louis Sessions Street
Lake Village, AR 71653
Phone (870) 265-5343

Other identifiers 1

IdentifierTypeStateIssuer
101396001MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060120000021 AR Practitioner - General Surgery 8729003751 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Arkansas College of Medicine, 1961
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Village Clinic PAGroup PAC ID 3274575162, 8 clinicians

Practice addresses (Care Compare)

2918 Louis Sessions St
Lake Village, AR 71653-6049
Phone (870) 265-5343

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C3006ARMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Village Clinic PA CurrentSince Jun 1, 1968 Accepting new patients
Chicot Memorial Medical Center PastSince May 1, 2010 Accepting new patients
Chicot Memorial Hospital Past Accepting new patients

Locations

2918 Louis Sessions St
Lake Village, AR 71653
Phone (870) 265-5343

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HCCAAA
  • Direct secure messaging: john.burge@lvcp.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Southeast Rehabilitation HospitalLake Village, AR, CCN 043034 Hospital 5% Or Greater Direct Ownership Interest Nov 1, 2006
Chicot Memorial Medical CenterLake Village, AR, CCN 04Z328 Hospital Corporate Director May 1, 2010
Chicot Memorial Medical CenterLake Village, AR, CCN 041328 Hospital Corporate Director May 1, 2010
Chicot Memorial Medical Center Home Health AgencyLake Village, AR, CCN 047104 Home health agency Corporate Director May 1, 2010
Southeast Rural Health ClinicLake Village, AR, CCN 048523 Rural health clinic 5% Or Greater Direct Ownership Interest Mar 1, 2020
Lake Village ClinicLake Village, AR, CCN 048564 Rural health clinic Corporate Director May 1, 2010

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1851370753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2918 LOUIS SESSIONS STREET",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "71653",
            "telephone_number": "870-265-5343",
            "fax_number": "870-265-5686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2918 LOUIS SESSIONS STREET",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "71653",
            "telephone_number": "870-265-5343",
            "fax_number": "870-265-5686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGE",
        "first_name": "JOHN",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-10",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "C3006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101396001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Village, AR

Sources for this page

Verify at the official NPI Registry.