Active NPI
Ellen Burgess, PH.D.
- Clinical Psychologist
- Rockville, MD
National Provider Identifier
1962794024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 04080
- Practice address
- 11119 Rockville Pike
Suite 200
Rockville, MD 20852-3143 - Phone
- (301) 633-3104
- NPI assigned
- May 9, 2011
- Last updated
- Jan 16, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 04080 | MD | Primary |
Addresses
Primary practice location
11119 Rockville Pike
Suite 200
Rockville, MD 20852-3143
Mailing address
6110 Wilmett Rd
Bethesda, MD 20817-2461
Phone (301) 633-3104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120308000068 | DC | Practitioner - Clinical Psychologist | 7517126741 | Practice locations: Rockville, MD |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
11119 Rockville Pike
Suite 200
Rockville, MD 20852-3143
Phone (301) 633-3104
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484524800000",
"number": "1962794024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6110 WILMETT RD",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208172461",
"telephone_number": "301-633-3104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11119 ROCKVILLE PIKE",
"address_2": "SUITE 200",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208523143",
"telephone_number": "301-633-3104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESS",
"first_name": "ELLEN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-09",
"last_updated": "2017-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "04080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2017; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.