Mary G Burgos, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010443 Issued in IL

Practice address

400 W Lake St
Elmhurst, IL 60126-1511

Phone

(630) 940-6629

Fax

(888) 388-2329

NPI assigned

Jun 29, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Burgos Fuentes Service Corporation

  • Primary Care Clinic/Center
  • Bensenville, IL
  • NPI 1154491348
  NPD (past)

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

{
    "created_epoch": "1309305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1982991980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W LAKE ST",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601261511",
            "telephone_number": "630-940-6629",
            "fax_number": "888-388-2329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W LAKE ST",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601261511",
            "telephone_number": "630-940-6629",
            "fax_number": "888-388-2329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGOS",
        "first_name": "MARY",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-29",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Buhr, MSW, LCSW
• Sara Marie Buikema, LCSW
• Diane Marola Bullock
• Michael Bumroongsuk
• Susan Frances Burgess, DMD
• Alyssa Christine Burns, MS, BCBA
• Florianne Pacheco Burns, OD
• Shirley Gordon Burnside, LCSW
• Maddalena Sofia Buscemi, DNP, CNM, APRN
• William Forest Bushnell III, D.P.M.

• Optometrist in Elmhurst, IL
• Providers in Elmhurst, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; 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.

Verify at the official NPI Registry.