Gregory E. Burgess, PA-C
Individual provider Active NPI Surgical Physician Assistant · Mauston, WI
NPI 1932458932 · NPPES record last updated Jan 24, 2019
Key facts
- NPI
- 1932458932
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- 3023-23 (WI)
- Practice address
- 1040 Division St
Mauston, WI 53948-1931 - Phone
- (608) 847-5000
- Fax
- (608) 847-9875
- NPI assigned
- Sep 5, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mile Bluff Medical Center Inc
Practice addresses (Care Compare)
1040 Division St
Mauston, WI 53948-1931
Phone (608) 847-1852
1050 Division St
Mauston, WI 53948-1931
Hospital & facility affiliations
- Mile Bluff Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121018000802 | WI | Practitioner - Physician Assistant | 1658521109 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3023-23 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mile Bluff Medical Center Inc | Current |
Accepting new patients | |
| Mile Bluff Medical Center Inc | Physician Assistant | Current | Accepting new patients |
Locations
1040 Division St
Mauston, WI 53948
Phone (608) 847-5000
1050 Division St
Mauston, WI 53948
Phone (608) 847-6161
28 Commerce St
Wisconsin Dells, WI 53965
Phone (608) 254-5888
Interoperability endpoints
- gregory.burgess@direct.milebluff.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 3023-23 | WI | Yes |
| Physician Assistant | 363A00000X | 3023-23 | WI |
Addresses
Primary practice location
1040 Division St
Mauston, WI 53948-1931
Mailing address
1040 Division St
Mauston, WI 53948-1931
Phone (608) 847-5000
NPI Registry JSON
{
"created_epoch": "1346803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548288000000",
"number": "1932458932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1040 DIVISION ST",
"city": "MAUSTON",
"state": "WI",
"postal_code": "539481931",
"telephone_number": "608-847-5000",
"fax_number": "608-847-9875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 DIVISION ST",
"city": "MAUSTON",
"state": "WI",
"postal_code": "539481931",
"telephone_number": "608-847-5000",
"fax_number": "608-847-9875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESS",
"first_name": "GREGORY",
"middle_name": "E.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-05",
"last_updated": "2019-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "WI",
"license": "3023-23",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "3023-23",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mauston, WI
- Stacey Boyes
- Randall Scott Brandt
- Roberta A Bronecki
- Judy A. Bronson
- Mary Ann Brown
- Kevin A Butterfield
- Megan Nicole Byrnes
- Tacy Camenga
- Kevin J Carrigan
- Jessica B Carroll
All providers in Mauston, WI · Surgical Physician Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.