Active NPI
Judith Burgess, MD
- Family Medicine Physician
- Conshohocken, PA
National Provider Identifier
1861483125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD053751
- Practice address
- 1 W Elm St
2ND Floor
Conshohocken, PA 19428-2007 - Phone
- (610) 567-6964
- Fax
- (610) 567-6170
- NPI assigned
- Nov 4, 2005
- Last updated
- Jan 17, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD053751 | PA | Primary |
Addresses
Primary practice location
1 W Elm St
2ND Floor
Conshohocken, PA 19428-2007
Mailing address
1 W Elm St
Ste 100
Conshohocken, PA 19428-4108
Phone (215) 473-1515
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0543935 | Other | PA | AETNA HMO |
| 5065448 | Other | PA | AETNA PPO |
| 1023774 | Other | PA | KEYSTONE MERCY |
| 0015279820006 | Medicaid | PA | |
| 0809734000 | Other | PA | KEYSTONE HEALTH PLAN EAST |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD053751 | PA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516147200000",
"number": "1861483125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 W ELM ST",
"address_2": "STE 100",
"city": "CONSHOHOCKEN",
"state": "PA",
"postal_code": "194284108",
"telephone_number": "215-473-1515",
"fax_number": "215-473-1515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 W ELM ST",
"address_2": "2ND FLOOR",
"city": "CONSHOHOCKEN",
"state": "PA",
"postal_code": "194282007",
"telephone_number": "610-567-6964",
"fax_number": "610-567-6170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESS",
"first_name": "JUDITH",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-04",
"last_updated": "2018-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MD053751",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "0543935",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "5065448",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE MERCY",
"identifier": "1023774",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0015279820006",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE HEALTH PLAN EAST",
"identifier": "0809734000",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conshohocken, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.