Individual provider Active NPI

Raymond R Burgess, D.O.

  • Family Medicine Physician
  • Port Charlotte, FL
National Provider Identifier
1992885214
Registry record updated Sep 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS5358 Issued in FL
Practice address
2315 Aaron St
Port Charlotte, FL 33952-5305
Phone
(941) 613-2222
Fax
(941) 627-9950
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2021

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 OS5358 FL Primary

Addresses

Primary practice location

2315 Aaron St
Port Charlotte, FL 33952-5305

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Other identifiers 1

IdentifierTypeStateIssuer
80020OtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20090218000527 FL Practitioner - Family Practice 5193890895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oklahoma State University College of Osteopathic Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

Practice addresses (Care Compare)

1065 Tamiami TRL N
Nokomis, FL 34275-2144
Phone (941) 477-2364

13691 Metro Pkwy
Fort Myers, FL 33912-4322

13807 Tamiami TRL
North Port, FL 34287-2069
Phone (941) 257-1108

13813 Metro Pkwy
Fort Myers, FL 33912-4343
Phone (239) 936-1343

13815 Tamiami TRL
North Port, FL 34287-2069
Phone (941) 426-4900

13823 Tamiami TRL
North Port, FL 34287-2069
Phone (941) 888-0770

150 W McKenzie St
Punta Gorda, FL 33950-5500
Phone (941) 621-6476

171 Ctr Rd
Venice, FL 34285-5572
Phone (941) 499-5407

177 Ctr Rd
Venice, FL 34285-5572
Phone (941) 207-5350

1940 Tamiami TRL
Suite 104
Port Charlotte, FL 33948-2105
Phone (941) 883-0083

19531 Cochran Blvd
Port Charlotte, FL 33948-2081
Phone (941) 255-3535

2315 Aaron St
Port Charlotte, FL 33952-5305
Phone (941) 613-2222

2335 Aaron St
Port Charlotte, FL 33952-5305
Phone (941) 787-7665

2343 Aaron St
Port Charlotte, FL 33952-5305
Phone (941) 629-2900

2675 Winkler Ave
Fort Myers, FL 33901-9328

2675 Winkler Avenue
Suite 200
Fort Myers, FL 33901-9328

4130 Tamiami TRL
Suite 2
Port Charlotte, FL 33952-9207
Phone (941) 787-7100

900 Pine St
Suite 221
Englewood, FL 34223-4458
Phone (941) 548-1708

Hospital & facility affiliations

  • Millennium Home Care LLC Home health agency, Port Charlotte, FL, CCN 109401
  • HCA Florida Fawcett Hospital Hospital, Port Charlotte, FL, CCN 100236

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5358FLMDOptometrist
OS5358FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC Family Medicine CurrentSince May 2, 2011 Accepting new patients
Millennium Physician Group LLC Family Medicine CurrentSince May 2, 2011 Accepting new patients
American Medic of Charlotte County PA Family Medicine PastSince Dec 1, 2007 Accepting new patients

Locations

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

3434 Hancock Bridge Pkwy
North Ft Myers, FL 33903

2315 Aaron St
Port Charlotte, FL 33952
Phone (941) 613-2222

2343 Aaron St
Pt Charlotte, FL 33952
Phone (855) 979-5700

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: raymond.burgess.1@4290.direct.athenahealth.com

Organizations & group practices 3

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.

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": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1992885214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 AARON ST",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525305",
            "telephone_number": "941-613-2222",
            "fax_number": "941-627-9950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "RAYMOND",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS5358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "80020",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.