NPIMap

Individual provider Active NPI

Charles M Burkett, M.D.

  • Diagnostic Radiology Physician
  • Daytona Beach, FL
National Provider Identifier
1215970231
Registry record updated Jul 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME0045020 Issued in FL
Practice address
1673 Mason Ave
Suite # 305
Daytona Beach, FL 32117-5515
Phone
(386) 274-7118
Fax
(386) 274-6173
NPI assigned
Jun 14, 2006
Last updated
Jul 1, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2010

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X ME0045020 FL
Neuroradiology Physician 2085N0700X ME0045020 FL
Nuclear Radiology Physician 2085N0904X ME0045020 FL
Pediatric Radiology Physician 2085P0229X ME0045020 FL
Diagnostic Radiology Physician 2085R0202X ME0045020 FL Primary
Therapeutic Radiology Physician 2085R0203X ME0045020 FL
Vascular & Interventional Radiology Physician 2085R0204X ME0045020 FL
Diagnostic Ultrasound Physician 2085U0001X ME0045020 FL

Addresses

Primary practice location

1673 Mason Ave
Suite # 305
Daytona Beach, FL 32117-5515

Mailing address

1673 Mason Ave
Suite # 305
Daytona Beach, FL 32117-5515
Phone (386) 274-7118

Other identifiers 2

IdentifierTypeStateIssuer
64542OtherFLBLUE CROSS BLUE SHIELD
041544800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0045020FLMDPediatric Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Central Florida Outpatient Imaging LLC Body Imaging Past Accepting new patients
East Central Florida Outpatient Imaging LLC Diagnostic Radiology Past Accepting new patients
East Central Florida Outpatient Imaging LLC Body Imaging Past Accepting new patients
East Central Florida Outpatient Imaging LLC Diagnostic Radiology Past Accepting new patients
Halifax Healthcare Systems Inc Diagnostic Radiology Past Accepting new patients
East Central Florida Outpatient Imaging LLC Diagnostic Radiology Past Accepting new patients
East Central Florida Outpatient Imaging, LLC Body Imaging Past Accepting new patients
East Central Florida Outpatient Imaging, LLC Diagnostic Radiology Past Accepting new patients
East Central Florida Outpatient Imaging LLC Body Imaging Past Accepting new patients
East Central Florida Outpatient Imaging, LLC Body Imaging Past Accepting new patients
East Central Florida Outpatient Imaging, LLC Body Imaging Past Accepting new patients

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277942400000",
    "number": "1215970231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1673 MASON AVE",
            "address_2": "SUITE # 305",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175515",
            "telephone_number": "386-274-7118",
            "fax_number": "386-274-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1673 MASON AVE",
            "address_2": "SUITE # 305",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175515",
            "telephone_number": "386-274-7118",
            "fax_number": "386-274-6173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKETT",
        "first_name": "CHARLES",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2010-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "FL",
            "license": "ME0045020",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "FL",
            "license": "ME0045020",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "FL",
            "license": "ME0045020",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "FL",
            "license": "ME0045020",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME0045020",
            "primary": true
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "FL",
            "license": "ME0045020",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "FL",
            "license": "ME0045020",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "FL",
            "license": "ME0045020",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "64542",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041544800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.