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DR. JAMES PAUL BURKE M.D., PH.D.
NPI 1720151855
Neurological Surgery in Altoona, PA

Active since November 16, 2006PECOS EnrolledAccepts Medicare Assignment
7.63/100
CMS Quality Rating
501 HOWARD AVE, BUILDING F-3, ALTOONA, PA 16601(814) 946-9150(814) 946-1397 Get Directions Write a Review

NPPES record last updated: April 30, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. James Paul Burke M.d., Ph.d. NPPES

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

DR. JAMES PAUL BURKE M.D., PH.D. (NPI 1720151855) is an individual neurological surgery provider in Altoona, Pennsylvania, licensed in Pennsylvania (MD066471L) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS, is affiliated with Penn Highlands Huntingdon, and is a graduate of University Of Alabama School Of Medicine (1996).

NPPES Registry Identity

NPI1720151855
Entity TypeIndividualMale
Primary Taxonomy207T00000X
Provider Legal NameDR. JAMES PAUL BURKECredential: M.D., PH.D.
Location Address501 HOWARD AVE, BUILDING F-3Altoona, PA 16601
Mailing Address501 Howard Ave Ste E1Altoona, PA 16601-4817 · (814) 946-9150 · Fax (814) 946-1397
Phone(814) 946-9150
Fax(814) 946-1397
Sole ProprietorNo
Medical School CMSUniversity Of Alabama School Of MedicineGraduated 1996
Enumeration DateNovember 16, 2006
Last NPPES UpdateApril 30, 2020
NPPES CertifiedApril 30, 2020
✔ NPI 1720151855 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNeurological SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207T00000X
License✔ Licensed in PA · MD066471L
Definition
A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.
501 HOWARD AVE, Altoona, PA 16601
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. James Paul Burke M.d., Ph.d. 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 ID9739237173
PECOS Enrollment IDI20100426000390
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.

Areas of Expertise CMS Part B claims 14

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
120 services111 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
57 services48 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
54 services52 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
49 services25 patients
Fusion of additional segment of spine 22614
Fusion of an additional segment of the spine is a surgical procedure to join two or more vertebrae together. This is done to stabilize the spine and reduce pain or correct a deformity. The procedure involves using bone grafts, rods, or screws to secure the spine.
44 services14 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
43 services17 patients

Hospital Affiliations CMS Care Compare 5

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

Penn Highlands Huntingdon

Acute Care Hospitals · Huntingdon, PA
3/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number390056
Location1225 Warm Springs AveHuntingdon, PA 16652 · Huntingdon County
Emergency services

Conemaugh Nason Medical Center

Acute Care Hospitals · Roaring Spring, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number390062
Location105 Nason DriveRoaring Spring, PA 16673 · Blair County
Emergency services

Upmc Altoona

Acute Care Hospitals · Altoona, PA
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390073
Location620 Howard AvenueAltoona, PA 16601 · Blair County
Emergency services Birthing friendly

Penn Highlands Dubois

Acute Care Hospitals · Dubois, PA
2/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number390086
Location100 Hospital AvenueDubois, PA 15801 · Clearfield County

Upmc Bedford Memorial

Acute Care Hospitals · Everett, PA
OwnershipVoluntary non-profit - Private
CMS Certification Number390117
Location10455 Lincoln HighwayEverett, PA 15537 · Bedford County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 16601 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$126.34 typical visit price
range $54.64 – $166.87
Typical copayment $31.58 (range $13.66 – $41.71)
Most-billed visit code 99204
Established Patient
$68.36 typical visit price
range $17.33 – $135.84
Typical copayment $17.09 (range $4.33 – $33.96)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

7.63/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality0
Improvement Activities0
Cost25.43

Reported Quality Measures

Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…
28%553 patients2/55-star benchmark: 100%
Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
100%2,223 patients5/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
73%158 patients3/55-star benchmark: 100%
Health Information Exchange
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…
4%227 patients1/55-star benchmark: 98%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
98%209 patients4/55-star benchmark: 100%
Pain Assessment and Follow-Up
Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present
9%1,915 patients1/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
6%465 patients1/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
73%1,309 patients3/55-star benchmark: 100%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
50%74 patients3/55-star benchmark: 100%
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling
Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user
82%402 patients4/55-star benchmark: 100%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
100%465 patients5/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
6%465 patients1/55-star benchmark: 79%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Osteogenesis stimulator, electrical, non-invasive, spinal applications E0748
DME-Other DME · category DE000N
2 suppliers22 claims22 services$3,753.21 avg. paid by Medicare
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0631
DME-Orthotic Devices · category DF007N
1 supplier11 claims11 services$834.92 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

DR. JAMES ALLEN PRUITT MD
Emergency Medicine
501 HOWARD AVE, F2
ALTOONA, PA 16601
Blair County (480) 825-1256
KOPP PHARMACY
Pharmacist
501 HOWARD AVE, BLDG G
ALTOONA, PA 16601
Blair County (814) 943-0621
BLAIR RENAL ASSOCIATES INC
Internal Medicine (Nephrology)
501 HOWARD AVE, SUITE D204
ALTOONA, PA 16601
Blair County (814) 944-2107
TERESA ROSE PRESTON PA-C
Physician Assistant
501 HOWARD AVE, SUITE B204
ALTOONA, PA 16601
Blair County (814) 889-6111
JENNIFER VARGO SAXION AU.D.
Audiologist
501 HOWARD AVE, D203
ALTOONA, PA 16601
Blair County (814) 946-0721
STANLEY WALTER SRAL JR.
Counselor (Mental Health)
501 HOWARD AVE
ALTOONA, PA 16601
Blair County (814) 889-2141
VERONICA LI MD
Family Medicine
501 HOWARD AVE, SUITE F2
ALTOONA, PA 16601
Blair County (814) 889-2701
SARAH SCHROEDER
Obstetrics & Gynecology
501 HOWARD AVE, ALLEGHENY FAMILY PHYSICIANS
ALTOONA, PA 16601
Blair County (814) 889-2020

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 James Burke's NPI number?

The NPI number for James Burke is 1720151855. It was assigned to this individual provider in the NPPES registry on November 16, 2006.

Where is James Burke located?

James Burke practices at 501 Howard Ave Building F-3, Altoona, PA 16601. The listed phone number is (814) 946-9150.

What is James Burke's specialty?

The primary specialty registered for this NPI is Neurological Surgery with taxonomy code 207T00000X.

Is James Burke enrolled in Medicare?

Yes. James Burke 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.

What insurance does James Burke accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Buckeye Health Plan list James Burke as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is James Burke affiliated with any hospitals?

According to CMS data, James Burke is affiliated with Penn Highlands Huntingdon, Conemaugh Nason Medical Center, Upmc Altoona, Penn Highlands Dubois and Upmc Bedford Memorial.

When was this NPI record last updated?

The NPPES record for James Burke was last updated on April 30, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.