NPIMap

Individual provider Active NPI

Matt James Burch

  • Professional Counselor
  • Hoschton, GA
National Provider Identifier
1972987899
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
005247 Issued in GA
Practice address
4073 Highway 53
Hoschton, GA 30548-2305
Phone
(770) 882-5884
Fax
(706) 658-0116
NPI assigned
Jul 10, 2015
Last updated
Jul 10, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 005247 GA Primary

Addresses

Primary practice location

4073 Highway 53
Hoschton, GA 30548-2305

Mailing address

4073 Highway 53
Hoschton, GA 30548-2305
Phone (770) 882-5884

Other identifiers 1

IdentifierTypeStateIssuer
003154238AMedicaidGA

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
005247GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Georgia Psychological Services LLC PastSince May 1, 2015 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1436486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436486400000",
    "number": "1972987899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4073 HIGHWAY 53",
            "city": "HOSCHTON",
            "state": "GA",
            "postal_code": "305482305",
            "telephone_number": "770-882-5884",
            "fax_number": "706-658-0116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4073 HIGHWAY 53",
            "city": "HOSCHTON",
            "state": "GA",
            "postal_code": "305482305",
            "telephone_number": "770-882-5884",
            "fax_number": "706-658-0116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURCH",
        "first_name": "MATT",
        "middle_name": "JAMES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-10",
        "last_updated": "2015-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "005247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003154238A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hoschton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.