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NICHOLAS TATE BURRIS
NPI 1417651969
Student in an Organized Health Care Education/Training Program in Madisonville, KY

Active since March 29, 2023PECOS EnrolledAccepts Medicare Assignment
900 HOSPITAL DR, MADISONVILLE, KY 42431(270) 825-5100 Get Directions Write a Review

NPPES record last updated: March 29, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Nicholas Tate Burris NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICHOLAS TATE BURRIS (NPI 1417651969) is an individual student in an organized health care education/training program in Madisonville, Kentucky and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS, is affiliated with Baptist Health Deaconess Madisonville, and is a graduate of University Of Louisville School Of Medicine (2025).

NPPES Registry Identity

NPI1417651969
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameNICHOLAS TATE BURRIS
Location Address900 HOSPITAL DRMadisonville, KY 42431-1644
Mailing Address380 Country Club Ln Apt FMadisonville, KY 42431-3836 · (270) 619-1609
Phone(270) 825-5100
Sole ProprietorNo
Medical School CMSUniversity Of Louisville School Of MedicineGraduated 2025
Enumeration DateMarch 29, 2023
NPPES CertifiedMarch 29, 2023
✔ NPI 1417651969 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
900 HOSPITAL DR, Madisonville, KY 42431
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nicholas Tate Burris is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8022572163
PECOS Enrollment IDI20260709004288
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Nicholas Burris reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Baptist Health Deaconess Medical Group Inc
Same address
Rural Health
800 HOSPITAL DR FL 2
Madisonville, KY 42431
  • Reassigned Medicare billing, Kentucky enrollment
  • 325 clinicians in this Medicare group
NPI 1144804311 (270) 326-3900

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Baptist Health Deaconess Madisonville

Acute Care Hospitals · Madisonville, KY
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number180093
Location900 Hospital DriveMadisonville, KY 42431 · Hopkins County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CADE CUNNINGHAM
Pharmacist
900 HOSPITAL DR
MADISONVILLE, KY 42431
Hopkins County (270) 825-5250
BRIAN CORDELL GIBBS JR. CRNA
Nurse Anesthetist, Certified Registered
900 HOSPITAL DR
MADISONVILLE, KY 42431
Hopkins County (785) 717-9504
MICHAEL DAVID CRIDER CRNA
Nurse Anesthetist, Certified Registered
900 HOSPITAL DR
MADISONVILLE, KY 42431
Hopkins County (270) 825-5100
REGINA ANN HUNTER CSA
Specialist/Technologist, Other (Surgical Assistant)
900 HOSPITAL DR
MADISONVILLE, KY 42431
Hopkins County (270) 825-5100
STACEY LEIGH MCGREGOR CSA
Specialist/Technologist, Other (Surgical Assistant)
900 HOSPITAL DR
MADISONVILLE, KY 42431
Hopkins County (270) 825-5100
ASHLEIGH DENA HICKERSON APRN
Nurse Practitioner (Acute Care)
900 HOSPITAL DR
MADISONVILLE, KY 42431
Hopkins County (270) 875-3502
DEVALKUMAR JITENDRABHAI RAJYAGURU M.D.
Internal Medicine (Hematology & Oncology)
900 HOSPITAL DR
MADISONVILLE, KY 42431
Hopkins County (270) 825-5800
TRAVIS LAFFOON CRNA
Nurse Anesthetist, Certified Registered
900 HOSPITAL DR
MADISONVILLE, KY 42431
Hopkins County (270) 824-3682

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicholas Burris's NPI number?

The NPI number for Nicholas Burris is 1417651969. It was assigned to this individual provider in the NPPES registry on March 29, 2023.

Where is Nicholas Burris located?

Nicholas Burris practices at 900 Hospital Dr, Madisonville, KY 42431. The listed phone number is (270) 825-5100.

What is Nicholas Burris's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Nicholas Burris enrolled in Medicare?

Yes. Nicholas Burris is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Nicholas Burris's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicholas Burris reassigns Medicare benefits to Baptist Health Deaconess Medical Group Inc (Madisonville, KY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nicholas Burris's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Nicholas Burris affiliated with any hospitals?

According to CMS data, Nicholas Burris is affiliated with Baptist Health Deaconess Madisonville.

When was this NPI record last updated?

The NPPES record for Nicholas Burris was last updated on March 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.