EAST GEORGIA RADIOLOGY LLC – Diagnostic Radiology Physician, NPI 1003973207
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for EAST GEORGIA RADIOLOGY LLC
PO BOX 1368
STATESBORO, GA 30459
Phone: (912) 486-1339
Fax: (912) 871-2424
Type: Mailing
East Georgia Regional Medical Center, 1499, Fair Road, Somerset, Statesboro, Bulloch County, Georgia, 30458, United States
STATESBORO, GA 304581683
Phone: (912) 486-1339
Fax: (912) 871-2424
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2026-03-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-07-31 (1045 days ago).
Enrollment records
19
Earliest due date
2023-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20070306000531 | O | Clinic/Group Practice | GA | 2023-07-31 |
| O20250210000953 | O | Clinic/Group Practice | FL | TBD |
| O20250210001991 | O | Clinic/Group Practice | CO | TBD |
| O20250210003560 | O | Clinic/Group Practice | TX | TBD |
| O20250213003334 | O | Clinic/Group Practice | PA | TBD |
| O20250217000048 | O | Clinic/Group Practice | DC | TBD |
| O20250218001500 | O | Clinic/Group Practice | CA | TBD |
| O20250220001897 | O | Clinic/Group Practice | WA | TBD |
| O20250304003808 | O | Clinic/Group Practice | NE | TBD |
| O20250305002601 | O | Clinic/Group Practice | AZ | TBD |
| O20250307003447 | O | Clinic/Group Practice | NM | TBD |
| O20250311001176 | O | Clinic/Group Practice | TN | TBD |
| O20250313002914 | O | Clinic/Group Practice | MO | TBD |
| O20250318002791 | O | Clinic/Group Practice | OH | TBD |
| O20250326000942 | O | Clinic/Group Practice | MA | TBD |
| O20251016004531 | O | Clinic/Group Practice | NC | TBD |
| O20251020001394 | O | Clinic/Group Practice | SC | TBD |
| O20251216000294 | O | Clinic/Group Practice | IA | TBD |
| O20260305002393 | O | Clinic/Group Practice | NH | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30459)
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