NPIMap

Individual provider Active NPI

Jon Patrick Burdzy, DO

  • Family Medicine Physician
  • Fort Myers, FL
National Provider Identifier
1205854510
Registry record updated Aug 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS7953 Issued in FL
Practice address
7381 College Pkwy
Suite 110
Fort Myers, FL 33907-5548
Phone
(239) 482-1010
Fax
(239) 481-1481
NPI assigned
Jul 17, 2006
Last updated
Aug 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS7953 FL Primary

Addresses

Primary practice location

7381 College Pkwy
Suite 110
Fort Myers, FL 33907-5548

Mailing address

12730 New Brittany Blvd Ste 602
Fort Myers, FL 33907-4690
Phone (239) 275-5522

Other identifiers 2

IdentifierTypeStateIssuer
44020OtherFLFLORIDA BLUE
003435900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040730000749 FL Practitioner - Family Practice 8224008719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

7381 College Pkwy
Suite 110
Fort Myers, FL 33907-5527
Phone (239) 482-1010

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS7953FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Primary Care of Southwest Florida PL Family Medicine CurrentSince May 1, 2011 Accepting new patients
Jon P. Burdzy, D.O., P.a. PastSince Sep 1, 2005 Accepting new patients
Roanoke Medical Center Past Accepting new patients

Locations

1255 Viscaya Pkwy
Ste 200
Cape Coral, FL 33990
Phone (239) 574-1988

1265 Viscaya Pkwy
Cape Coral, FL 33990
Phone (239) 573-7337

12730 New Brittany Blvd
Ste 200
Fort Myers, FL 33907
Phone (239) 275-5857

12730 New Brittany Blvd
Ste 602
Fort Myers, FL 33907
Phone (239) 275-5522

13195 Metro Pkwy
Ste 8
Fort Myers, FL 33966
Phone (239) 482-1010

7381 College Pkwy
Ste 110
Fort Myers, FL 33907
Phone (239) 482-1010

7780 Cambridge Manor Pl
Ste C
Fort Myers, FL 33907
Phone (239) 275-6778

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Shell Point - Larsen PavilionFort Myers, FL, CCN 105966 Skilled nursing facility Corporate Director Jan 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597968000000",
    "number": "1205854510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12730 NEW BRITTANY BLVD STE 602",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339074690",
            "telephone_number": "239-275-5522",
            "fax_number": "239-275-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7381 COLLEGE PKWY",
            "address_2": "SUITE 110",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339075548",
            "telephone_number": "239-482-1010",
            "fax_number": "239-481-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURDZY",
        "first_name": "JON",
        "middle_name": "PATRICK",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS7953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "44020",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003435900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.