| Dr Richard Tyler Burgner, MD | |
|
1270 Friendship Rd, Braselton, GA 30517-5608 | |
| (770) 535-9391 | |
| (770) 533-4701 |
| Full Name | Dr Richard Tyler Burgner |
|---|---|
| Gender | Male |
| Speciality | Diagnostic Radiology |
| Experience | 11 Years |
| Location | 1270 Friendship Rd, Braselton, Georgia |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053730481 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | ME139284 (Florida) | Secondary |
| 2085R0202X | Radiology - Diagnostic Radiology | 74713 (Georgia) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Memorial University Medical Center | Savannah, GA | Hospital |
| Hilton Head Regional Medical Center | Hilton head island, SC | Hospital |
| Coastal Carolina Hospital | Hardeeville, SC | Hospital |
| Effingham Health System | Springfield, GA | Hospital |
| Wayne Memorial Hospital | Jesup, GA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| The Longstreet Clinic, Pc | 2668465733 | 144 |
| Atlantic Radiology Associates Llc | 5799706032 | 112 |
| Outpatient Imaging, Llc | 8022029149 | 17 |
| Atlantic Radiology Associates Llc | 5799706032 | 112 |
| Entity Name | The Longstreet Clinic, Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1326019977 PECOS PAC ID: 2668465733 Enrollment ID: O20040405001521 |
| Entity Name | Atlantic Radiology Associates Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033136080 PECOS PAC ID: 5799706032 Enrollment ID: O20051214000206 |
| Entity Name | Outpatient Imaging, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1053386219 PECOS PAC ID: 8022029149 Enrollment ID: O20060605000128 |
| Entity Name | South Georgia Radiology Associates Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760669931 PECOS PAC ID: 0042389231 Enrollment ID: O20080514000110 |
| Entity Name | Department Of Behavioral Health And Developmental Disabilities |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1902030307 PECOS PAC ID: 7416002506 Enrollment ID: O20090825000435 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Richard Tyler Burgner, MD 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 Ph: (904) 953-2000 | Dr Richard Tyler Burgner, MD 1270 Friendship Rd, Braselton, GA 30517-5608 Ph: (770) 535-9391 |