NPIMap

Individual provider Active NPI

Richard J Breckwoldt, M.D.

  • Internal Medicine Physician
  • Hiram, GA
National Provider Identifier
1942297106
Registry record updated Jun 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
039295 Issued in GA
Practice address
5604 Wendy Bagwell Pkwy
Suite 711
Hiram, GA 30141-7813
Phone
(678) 384-0800
Fax
(678) 384-0801
NPI assigned
Oct 4, 2005
Last updated
Jun 16, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 39295 GA
Internal Medicine Physician 207R00000X 039295 GA Primary

Addresses

Primary practice location

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

Mailing address

5604 Wendy Bagwell Pkwy
Suite 711
Hiram, GA 30141-7813
Phone (678) 384-0800

Other identifiers 1

IdentifierTypeStateIssuer
000656103BMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051101000439 GA Practitioner - Internal Medicine 2264459908 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York Medical College, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Piedmont Medical Care CorporationGroup PAC ID 6002802220, 368 clinicians

Practice addresses (Care Compare)

105 Collier Rd NW
Suite 5020
Atlanta, GA 30309-1731
Phone (404) 367-3210

3820 Medical Park Dr
Suite 1100
Austell, GA 30106-1110
Phone (770) 874-0692

5604 Wendy Bagwell Pkwy
Suite 711
Hiram, GA 30141-7819
Phone (678) 384-0800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
039295GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Medical Care Corporation Internal Medicine CurrentSince Feb 1, 2014 Accepting new patients
Piedmont Providers LLC Internal Medicine Past Accepting new patients

Locations

105 Collier Rd NW
Ste 2070
Atlanta, GA 30309
Phone (404) 350-3860

105 Collier Rd NW
Ste 5020
Atlanta, GA 30309
Phone (404) 350-3860

2727 Paces Ferry Rd SE
Ste 1-1100
Atlanta, GA 30339
Phone (470) 271-3421

3820 Medical Park Dr
#1100
Austell, GA 30106
Phone (770) 874-0692

5604 Wendy Bagwell Pkwy
Ste 711
Hiram, GA 30141
Phone (678) 384-0800

Organizations & group practices 4

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 6

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": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402876800000",
    "number": "1942297106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5604 WENDY BAGWELL PKWY",
            "address_2": "SUITE 711",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301417813",
            "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": "SUITE 711",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301417813",
            "telephone_number": "678-384-0800",
            "fax_number": "678-384-0801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRECKWOLDT",
        "first_name": "RICHARD",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2014-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "39295",
            "primary": false
        },
        {
            "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": []
}

Other providers in Hiram, GA

Sources for this page

Verify at the official NPI Registry.