Active NPI
Georgiy Vladimirovich Brusovanik, MD
- Orthopaedic Surgery Physician
- Miami, FL
National Provider Identifier
1033315239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- MDR-4545
- Practice address
- 4770 Biscayne Blvd Ste 1100
Miami, FL 33137-3247 - Phone
- (305) 467-5678
- Fax
- (305) 821-6782
- NPI assigned
- Jun 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | MDR-4545 | HI | Primary |
Addresses
Primary practice location
4770 Biscayne Blvd Ste 1100
Miami, FL 33137-3247
Mailing address
4770 Biscayne Blvd Ste 1100
Miami, FL 33137-3247
Phone (305) 467-5678
Other names 1
- Dr. Gosha V Brusovanik
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2017 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MDR-4545 | HI | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shagalov Dermatology PA | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dermatology Physician
- Miami, FL
- NPI 1972231405
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714003200000",
"number": "1033315239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4770 BISCAYNE BLVD STE 1100",
"city": "MIAMI",
"state": "FL",
"postal_code": "331373247",
"telephone_number": "305-467-5678",
"fax_number": "305-821-6782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4770 BISCAYNE BLVD STE 1100",
"city": "MIAMI",
"state": "FL",
"postal_code": "331373247",
"telephone_number": "305-467-5678",
"fax_number": "305-821-6782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUSOVANIK",
"first_name": "GEORGIY",
"middle_name": "VLADIMIROVICH",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-25",
"last_updated": "2024-04-25",
"certification_date": "2024-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "HI",
"license": "MDR-4545",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "GOSHA",
"last_name": "BRUSOVANIK",
"middle_name": "V",
"prefix": "DR.",
"credential": "MD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.