NPIMap

Individual provider Active NPI

Mark Otto Bernardy, MD

  • Diagnostic Radiology Physician
  • Conyers, GA
National Provider Identifier
1861478588
Registry record updated Feb 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
028502 Issued in GA
Practice address
1031 Jimson Dr SE
Conyers, GA 30013-2064
Phone
(800) 879-6274
Fax
(678) 342-2547
NPI assigned
Dec 15, 2005
Last updated
Feb 29, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 028502 GA Primary

Addresses

Primary practice location

1031 Jimson Dr SE
Conyers, GA 30013-2064

Mailing address

1031 Jimson Dr SE
Conyers, GA 30013-2064
Phone (800) 879-6274

Other identifiers 1

IdentifierTypeStateIssuer
P00256142OtherRR MEDICARE

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)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Associates of Savannah, PC Past Accepting new patients
Rockdale Diagnostics, LLC Past Accepting new patients
Diagnostic Health Corporation Past Accepting new patients
American Health Imaging of Georgia LLC Past Accepting new patients
Milstead Pathology, PC PastSince Sep 11, 2001 Accepting new patients
Diagnostic Imaging Specialists PA Diagnostic Radiology Past Accepting new patients
Diagnostic Health Corporation Past Accepting new patients
Rockdale Pathology, PC Past Accepting new patients

Organizations & group practices 8

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": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204243200000",
    "number": "1861478588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 JIMSON DR SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132064",
            "telephone_number": "800-879-6274",
            "fax_number": "678-342-2547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 JIMSON DR SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132064",
            "telephone_number": "800-879-6274",
            "fax_number": "678-342-2547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNARDY",
        "first_name": "MARK",
        "middle_name": "OTTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2008-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "028502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00256142",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2008; 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.