Individual provider Active NPI

Goran Broketa, MD

  • Hematology & Oncology Physician
  • Manchester, NH
National Provider Identifier
1033153374
Registry record updated Nov 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
MD060211L Issued in PA
Practice address
718 Smyth Rd
Manchester, NH 03104-7007
Phone
(603) 624-4366
Fax
(603) 629-3217
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X MD060211L PA Primary

Addresses

Primary practice location

718 Smyth Rd
Manchester, NH 03104-7007

Mailing address

718 Smyth Rd
Manchester, NH 03104-7007
Phone (603) 624-4366

Other identifiers 6

IdentifierTypeStateIssuer
02148570MedicaidNY
0018385800001MedicaidPA
830007394OtherPARR MEDICARE PIN
GU039777OtherPAMEDICARE GROUP
GU039841OtherPAMEDICARE GROUP
CC9269OtherPARR MEDICARE GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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
I20120822000316 NH Order and Referring Only - Hematology/OncologyPractitioner - Hematology/Oncology 2466478565

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0113NHMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Guthrie Medical Group PC Past Accepting new patients
Guthrie Medical Group, P.C. Past Accepting new patients
Guthrie Medical Group, P.C. Hematology & Oncology Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289520000000",
    "number": "1033153374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 SMYTH RD",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031047007",
            "telephone_number": "603-624-4366",
            "fax_number": "603-629-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 SMYTH RD",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031047007",
            "telephone_number": "603-624-4366",
            "fax_number": "603-629-3217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROKETA",
        "first_name": "GORAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2010-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "PA",
            "license": "MD060211L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02148570",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018385800001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "830007394",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "GU039777",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "GU039841",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP",
            "identifier": "CC9269",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

Verify at the official NPI Registry.