Richard Burgess
Individual provider Active NPI Physician Assistant · Fort Myers, FL
NPI 1003288754 · NPPES record last updated Oct 29, 2021
Key facts
- NPI
- 1003288754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA9109174 (FL)
- Practice address
- 3840 Colonial Blvd Ste 1
Fort Myers, FL 33966-1126 - Phone
- (855) 778-6262
- Fax
- (855) 778-3262
- NPI assigned
- Oct 21, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- You and Your Health Family Care Inc
Practice addresses (Care Compare)
1840 Classique Lane
Tavares, FL 32778-5748
1840 Classique LN
Tavares, FL 32778-5748
Phone (352) 508-5046
Hospital & facility affiliations
- Adventhealth Waterman
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151216000957 | FL | Practitioner - Physician Assistant | 3577864545 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3291 | TN | MD | Psychologist |
| PA9109174 | FL | MD | Physician Assistant |
Practice roles (2 of 4)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elk River Physicians Group, PLLC | Past | Accepting new patients | |
| Ante Rudez MD PA | Past | Accepting new patients |
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JIIIAD/Endpoint/JIIIAD
- richard.burgess.1@17743.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9109174 | FL | Yes |
Addresses
Primary practice location
3840 Colonial Blvd Ste 1
Fort Myers, FL 33966-1126
Mailing address
3840 Colonial Blvd Ste 1
Fort Myers, FL 33966-1126
Phone (855) 778-6262
Other providers in Fort Myers, FL
- Jon Patrick Burdzy
- Frederick J. Burford II
- Burg Foot & Ankle PA
- Carrie Burgess
- Kaylee Burgess
- Kenadee Burgoyne
- Peggy Burk
- Krizia Kiziswa Burke-Forde
- Brandi Leigh Burke
- Celia M Burke
All providers in Fort Myers, FL · Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.