Richard I Breazeale, M.D.

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

31597 Issued in TN

Practice address

1605 Williams Rd
Ste 201
Hixson, TN 37343-4934

Phone

(423) 756-1512

Fax

(423) 756-1004

NPI assigned

Jun 22, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TN

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

Merit-based Incentive Payment System (MIPS)

Final score

90.61 of 100Reported as group

Quality

86.74

Promoting interoperability

93

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southeastern Retina Associates, P.C.

  • Retina Specialist (Ophthalmology) Physician
  • Knoxville, TN
  • NPI 1932200664

  Retina Specialist

  NPD (past)
• Southeastern Retina Associates, P.C.

  • Retina Specialist (Ophthalmology) Physician
  • Kingsport, TN
  • NPI 1932370145

  Retina Specialist

  NPD (past)

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1801892146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 PROSPERITY DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234709",
            "telephone_number": "423-756-1512",
            "fax_number": "423-756-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 WILLIAMS RD",
            "address_2": "STE 201",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373434934",
            "telephone_number": "423-756-1512",
            "fax_number": "423-756-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREAZEALE",
        "first_name": "RICHARD",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "GA",
            "license": "56089",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "TN",
            "license": "31597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000860318C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009937405",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3841514",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000860318E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rona L Boykin, LCSW
• Catherine Agnes Bracks, OT
• Carolyn C Brannon, MD
• Sonia Bravo, D.M.D.
• Ethan Braytenbah
• Brian K Schenck Oral Surgery, PC
• Brian Webb DDS
• Emily Kristen Bridgers
• George M Brock, D.D.S., M.S.D.
• Lauren Elaine Brock

• All providers in Hixson, TN
• Retina Specialist (Ophthalmology) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.