Premier Internal Medicine

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

039295 Issued in GA

Legal business name

PREMIER INTERNAL MEDICINE

Practice address

5604 Wendy Bagwell Pkwy
Ste 711
Hiram, GA 30141-7813

Phone

(678) 384-0800

Fax

(678) 384-0801

NPI assigned

Apr 10, 2007

Last updated

Sep 29, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Richard J Breckwoldt, M.D.NPI 1942297106

Title

Medical Director

Phone

(678) 384-0800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• RICHARD J. BRECKWOLDT,M.D. Other name

Locations

Interoperability endpoints

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard J Breckwoldt, M.D.

  • Internal Medicine Physician
  • Hiram, GA
  • NPI 1942297106
  Authorized official Same address or phone

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285718400000",
    "number": "1659494847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5604 WENDYBAGWELL PKWY (HWY 278)",
            "address_2": "SUITE 711",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301412291",
            "telephone_number": "678-384-0800",
            "fax_number": "678-384-0801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5604 WENDY BAGWELL PKWY",
            "address_2": "STE 711",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301417813",
            "telephone_number": "678-384-0800",
            "fax_number": "678-384-0801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2010-09-29",
        "status": "A",
        "authorized_official_last_name": "BRECKWOLDT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "678-384-0800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "039295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000656103B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RICHARD J. BRECKWOLDT,M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Physicians Pain Clinic of Hiram, P.C.
• Physiotherapy Associates Inc (Physio-Hiram)
• Pinnacle Orthopaedics & Sports Medicine Specialists LLC
• Pinnacle Pediatrics PC
• Marcus Q. Polk, M.D.
• Presto Medical Supplies Inc
• Debra Price, MA, LPC, CPCS
• Juliette Pridgen
• Casey Pridgeon
• Providence Foot & Ankle Centers, PC, Inc

• Internal Medicine Physician in Hiram, GA
• Providers in Hiram, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.