Active NPI
Goran Broketa, MD
- Hematology & Oncology Physician
- Manchester, NH
National Provider Identifier
1033153374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- MD060211L
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02148570 | Medicaid | NY | |
| 0018385800001 | Medicaid | PA | |
| 830007394 | Other | PA | RR MEDICARE PIN |
| GU039777 | Other | PA | MEDICARE GROUP |
| GU039841 | Other | PA | MEDICARE GROUP |
| CC9269 | Other | PA | RR 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120822000316 | NH | Order and Referring Only - Hematology/Oncology | 2466478565 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0113 | NH | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New 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.
-
- Clinical Medical Laboratory
- Sayre, PA
- NPI 1649225855
-
- General Practice Physician
- Sayre, PA
- NPI 1245246644
Hematology & Oncology
-
- Family Medicine Physician
- Troy, PA
- NPI 1376592493
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.