Active NPI
Lisa Jean Burckhartzmeyer, MD
- Psychiatry Physician
- Peoria, IL
National Provider Identifier
1962674820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 036129370
- Practice address
- 228 NE Jefferson St
Peoria, IL 61602 - Phone
- (309) 671-8000
- Fax
- (309) 671-4695
- NPI assigned
- Mar 31, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 036129370 | IL | Primary |
Addresses
Primary practice location
228 NE Jefferson St
Peoria, IL 61602
Mailing address
2214 N University St
Peoria, IL 61604
Phone (309) 680-7634
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036129370 | Medicaid | IL |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Major Hospital | Past | Accepting new patients | |
| Sinnissippi Centers, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Rochelle, IL
- NPI 1407143837
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454630400000",
"number": "1962674820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2214 N UNIVERSITY ST",
"city": "PEORIA",
"state": "IL",
"postal_code": "61604",
"telephone_number": "309-680-7634",
"fax_number": "309-676-5506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "228 NE JEFFERSON ST",
"city": "PEORIA",
"state": "IL",
"postal_code": "61602",
"telephone_number": "309-671-8000",
"fax_number": "309-671-4695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURCKHARTZMEYER",
"first_name": "LISA",
"middle_name": "JEAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-31",
"last_updated": "2016-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "036129370",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036129370",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.