NPIMap

Individual provider Active NPI

Mary Burgeson, M.D.

  • Family Medicine Physician
  • Huntingburg, IN
National Provider Identifier
1972565026
Registry record updated Feb 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01028935 Issued in IN
Practice address
407 E 22ND St
Huntingburg, IN 47542-8964
Phone
(812) 683-3612
Fax
(812) 683-2819
NPI assigned
Apr 4, 2006
Last updated
Feb 3, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01028935 IN Primary

Addresses

Primary practice location

407 E 22ND St
Huntingburg, IN 47542-8964

Mailing address

PO Box 1028
Jasper, IN 47547-1028
Phone (812) 996-5255

Other identifiers 1

IdentifierTypeStateIssuer
100325260MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20070821000093 IN Practitioner - Family Practice 2860410206 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

407 E 22ND St
Memorial Hospital and Health Care Ctr
Huntingburg, IN 47542-8964
Phone (812) 996-3612

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions21
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01028935INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Memorial Medical Center Inc Family Medicine Current Accepting new patients
Deaconess Memorial Medical Center Inc CurrentSince Jun 18, 2007 Accepting new patients
Deaconess Memorial Medical Center Inc Family Medicine Current Accepting new patients
Deaconess Memorial Medical Center Inc Family Medicine CurrentSince Jun 18, 2007 Accepting new patients
Major Hospital Past Accepting new patients
Heart to Heart Hospice of Southwest Indiana LLC Family Medicine PastSince Dec 1, 2021 Accepting new patients

Locations

214 E 17th St
Huntingburg, IN 47542
Phone (812) 683-3612

407 E 22nd St
Huntingburg, IN 47542
Phone (812) 683-3612

600 W 13th St
Ste 100
Jasper, IN 47546
Phone (812) 996-2345

800 W 9th St
Jasper, IN 47546
Phone (812) 482-2345

Interoperability endpoints

  • Direct secure messaging: mburgeson1056340@direct.deaconess.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Heart to Heart Hospice of Southwest Indiana LLCJasper, IN, CCN 151514 Hospice Contracted Managing Employee Dec 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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 10

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": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454457600000",
    "number": "1972565026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1028",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475471028",
            "telephone_number": "812-996-5255",
            "fax_number": "812-996-8497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E 22ND ST",
            "city": "HUNTINGBURG",
            "state": "IN",
            "postal_code": "475428964",
            "telephone_number": "812-683-3612",
            "fax_number": "812-683-2819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESON",
        "first_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-04",
        "last_updated": "2016-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01028935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100325260",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntingburg, IN

Sources for this page

Verify at the official NPI Registry.