NPIMap

Individual provider Active NPI

Amos Reid Burgess, DO

  • Emergency Medicine Physician
  • Roosevelt, UT
National Provider Identifier
1881905503
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
8858421-1204 Issued in UT
Practice address
250 W 300 N
Roosevelt, UT 84066-2336
Phone
(435) 722-4691
Fax
(435) 722-9291
NPI assigned
Jun 28, 2010
Last updated
Oct 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OH
Emergency Medicine Physician 207P00000X 34.010347 OH
Emergency Medicine Physician 207P00000X 8858421-1204 UT Primary

Addresses

Primary practice location

250 W 300 N
Roosevelt, UT 84066-2336

Mailing address

525 E Market St
Akron, OH 44304-1619

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20140113001231 UT Practitioner - Emergency Medicine 8022259845 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Uintah Basin Medical CenterGroup PAC ID 0244131944, 62 clinicians

Practice addresses (Care Compare)

250 W 300
75 2
Roosevelt, UT 84066-2336
Phone (435) 722-4691

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Uintah Basin Medical Center CurrentSince Jan 15, 2014 Accepting new patients
Uintah Basin Medical Center CurrentSince Jan 15, 2014 Accepting new patients
Alliance Medical Associates Inc Past Accepting new patients
Summa Emergency Associates Emergency Medicine Past Accepting new patients
Summa Emergency Associates, Inc. Emergency Medicine Past Accepting new patients

Locations

250 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691

250 W 300 N
#752
Roosevelt, UT 84066
Phone (435) 722-4691

Organizations & group practices 5

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 3

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": "1277683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1881905503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E MARKET ST",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443041619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W 300 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-722-4691",
            "fax_number": "435-722-9291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "AMOS",
        "middle_name": "REID",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-28",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34.010347",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "UT",
            "license": "8858421-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roosevelt, UT

Sources for this page

Verify at the official NPI Registry.