Organization Active NPI

Bryan G. Popovici, DPM, PC

  • Podiatrist
  • Liverpool, NY
National Provider Identifier
1033386206
Registry record updated Mar 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
NOO3830 Issued in NY
Legal business name
BRYAN G. POPOVICI, DPM, PC
Practice address
7304 Oswego Rd
Liverpool, NY 13090-3718
Phone
(315) 451-8256
Fax
(315) 451-2335
NPI assigned
May 15, 2008
Last updated
Mar 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2010

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

Authorized official

Name
Bryan G. Popovici, DPMNPI 1508834524
Title
Podiatrist
Phone
(315) 451-8256

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X NOO3830 NY Primary

Addresses

Primary practice location

7304 Oswego Rd
Liverpool, NY 13090-3718

Mailing address

7304 Oswego Road
Liverpool, N.Y. 13090
UM
Phone (315) 451-8256

Other identifiers 8

IdentifierTypeStateIssuer
0061216OtherNYGHI
57106OtherHEALTHNET
480005715OtherTRAVELERS MEDICARE
5219121OtherAETNA
040426015156OtherFIDELIS
100007266502OtherNYAMERICHOICE/UNITED HEALTHCARE
6813OtherTOTAL CARE
00920594MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080516000576 NY Part B Supplier - Clinic/Group Practice 3375515786 Receives reassigned benefits from 1 practitioner
Practice locations: Baldwinsville, NY; Liverpool, NY

National Provider Directory

National Provider Directory

Locations

7304 Oswego Rd
Liverpool, NY 13090
Phone (315) 451-8256

618 State St
Watertown, NY 13601
Phone (315) 782-0026

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268697600000",
    "number": "1033386206",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "7304 OSWEGO ROAD",
            "city": "LIVERPOOL",
            "state": "N.Y.",
            "postal_code": "13090",
            "telephone_number": "315-451-8256",
            "fax_number": "315-451-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7304 OSWEGO RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130903718",
            "telephone_number": "315-451-8256",
            "fax_number": "315-451-2335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN G. POPOVICI, DPM, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-15",
        "last_updated": "2010-03-16",
        "status": "A",
        "authorized_official_last_name": "POPOVICI",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "315-451-8256",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "NOO3830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0061216",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "57106",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVELERS MEDICARE",
            "identifier": "480005715",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5219121",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "040426015156",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE/UNITED HEALTHCARE",
            "identifier": "100007266502",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TOTAL CARE",
            "identifier": "6813",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00920594",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.