Roosevelt Boursiquot, M.D., M.PHIL

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

287069 Issued in NY

Practice address

470 Clarkson Ave
MSC#59
Brooklyn, NY 11203

Phone

(718) 270-7207

NPI assigned

Jun 29, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

HospitalistAlso: Internal Medicine

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, 2,809 clinicians

Port Emergency Medical Services PCGroup PAC ID 1456376177, 41 clinicians

North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mount Sinai Hospital Hospital, New York, NY, CCN 330024
• St John'S Episcopal Hospital at South Shore Hospital, Far Rockaway, NY, CCN 330395
• Staten Island University Hospital Hospital, Staten Island, NY, CCN 330160

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722

Interoperability endpoints

• Direct secure messaging: rooseveltboursiquot@mai.allscriptsdirect.net

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.

• Icahn School of Medicine at Mount Sinai

  • Orthopaedic Surgery Physician
  • New York, NY
  • NPI 1124550280
  Medicare reassignment Care Compare group NPD
• Port Emergency Medical Services, P.C.

  • Emergency Medicine Physician
  • Port Jefferson, NY
  • NPI 1912988395
  Medicare reassignment Care Compare group NPD
• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment Care Compare group
• University Physicians of Brooklyn, Inc.

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1366506271
  Medicare reassignment NPD
• Inhospital Physicians Corp

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1073971750

  NY

  Medicare reassignment NPD
• Eaw Medical Care PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Brooklyn, NY
  • NPI 1073778916
  NPD
• Icahn School of Medicine at Mount Sinai

  • Eyewear Supplier
  • New York, NY
  • NPI 1760227466
  NPD
• Maimonides Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1093777492
  NPD
• North Shore - Lij Medical PC

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD
• University Physicians of Brooklyn, Inc.

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1568419000
  NPD
• University Physicians of Brooklyn, Inc.

  • Child & Adolescent Psychiatry Physician
  • Brooklyn, NY
  • NPI 1689715476
  NPD
• Episcopal Health Services Inc

  • General Acute Care Hospital
  • Far Rockaway, NY
  • NPI 1346274537
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mount Sinai Hospital

  • Clinical Medical Laboratory
  • New York, NY
  • NPI 1033206362

  Hospital

  Care Compare affiliation
• Mount Sinai Hospital

  • General Acute Care Hospital
  • Long Island City, NY
  • NPI 1245248939
  Care Compare affiliation
• Mount Sinai Hospital

  • Rehabilitation Hospital
  • New York, NY
  • NPI 1669440327
  Care Compare affiliation
• Mount Sinai Hospital

  • General Acute Care Hospital
  • New York, NY
  • NPI 1932103413
  Care Compare affiliation
• Mount Sinai Hospital Pharmacy

  • General Acute Care Hospital
  • New York, NY
  • NPI 1225295512
  Care Compare affiliation
• Mount Sinai Hospital-Ambulance

  • Ambulance
  • New York, NY
  • NPI 1568601342

  Hospital

  Care Compare affiliation
• Staten Island University Hospital

  • General Acute Care Hospital
  • Staten Island, NY
  • NPI 1407877137
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1013399872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 DEKALB AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015425",
            "telephone_number": "718-250-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 CLARKSON AVE",
            "address_2": "MSC#59",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11203",
            "telephone_number": "718-270-7207"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Gustave L Levy Pl",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100296504",
            "country_code": "US",
            "telephone_number": "212-241-1653",
            "fax_number": "212-289-6393",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURSIQUOT",
        "first_name": "ROOSEVELT",
        "name_prefix": "Dr.",
        "credential": "M.D., M.PHIL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-29",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "287069",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "287069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05234079",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra Bourjolly
• Elma Annmarie Bourne, RN
• Janelle Bourne
• Loreen Bourne
• Mark Eligiusz Bourne, MD
• Debra Bouskila, MS ED/SPED
• Eden Tamar Bouskila
• Joseph Bouskila
• Muhammad Fouad Bouso, MD
• Janelle Bousquet, MA

• Internal Medicine Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.