Individual provider Active NPI

Richard Joseph Pierzchajlo, M.D.

  • Family Medicine Physician
  • Tifton, GA
National Provider Identifier
1639175680
Registry record updated Nov 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
022620 Issued in GA
Practice address
1489 Kennedy Rd
Tifton, GA 31794-4159
Phone
(229) 391-9931
Fax
(229) 391-9961
NPI assigned
Jun 23, 2005
Last updated
Nov 29, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2010

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 022620 GA Primary

Addresses

Primary practice location

1489 Kennedy Rd
Tifton, GA 31794-4159

Mailing address

1489 Kennedy Rd
Tifton, GA 31794-4159
Phone (229) 391-9931

Other identifiers 1

IdentifierTypeStateIssuer
000232647GMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101124000098 GA Practitioner - Family Practice 1759450455 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Primecare, LLCGroup PAC ID 2466648803, 2 clinicians

Practice addresses (Care Compare)

1489 Kennedy Rd
Tifton, GA 31794-4159
Phone 2293919931105

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
022620GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Primecare, LLC Family Medicine CurrentSince Jan 1, 2001 Accepting new patients

Locations

1489 Kennedy Rd
Tifton, GA 31794
Phone (229) 391-9931

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GBABAA/Endpoint/GBABAA

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290988800000",
    "number": "1639175680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1489 KENNEDY RD",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944159",
            "telephone_number": "229-391-9931",
            "fax_number": "229-391-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1489 KENNEDY RD",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944159",
            "telephone_number": "229-391-9931",
            "fax_number": "229-391-9961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIERZCHAJLO",
        "first_name": "RICHARD",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2010-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "022620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000232647G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.