Jeremy Wayne Burgin, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD3167 Issued in NM

Practice address

1800 Sheffield Dr Ste D
Clovis, NM 88101-4946

Phone

(575) 714-5055

Fax

(575) 762-9573

NPI assigned

Jul 23, 2009

Last updated

Jul 23, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Jeremy W Burgin, DDS

  • Dental Clinic/Center
  • Clovis, NM
  • NPI 1790494771
  NPD

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

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248307200000",
    "number": "1891925871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 SHEFFIELD DR STE D",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014946",
            "telephone_number": "575-714-5055",
            "fax_number": "575-762-9573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 SHEFFIELD DR STE D",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014946",
            "telephone_number": "575-714-5055",
            "fax_number": "575-762-9573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGIN",
        "first_name": "JEREMY",
        "middle_name": "WAYNE",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-23",
        "last_updated": "2009-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD3167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clarke A. Brunton Jr., D.O.
• Jessica Bryant, MA, CCC-SLP
• Sarah Grace Bryant
• Tyler Buchanan, FNP
• Marla Dianne Buckles, FNP
• Brittany Burkhalter
• Amanda Burress, MS, LMHC
• Larry Bussanmas, O.D.
• Refugia D Bustamante
• Anthony Bustos, CONTRACTS/CORRECTION

• General Practice Dentistry in Clovis, NM
• Providers in Clovis, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2009; 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.