Individual provider Active NPI

Robert Brovarnik

  • Physical Therapist
  • Santa Monica, CA
National Provider Identifier
1063281897
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
305300 Issued in CA
Practice address
2010 Wilshire Blvd
Santa Monica, CA 90403-5608
Phone
(310) 878-2540
NPI assigned
Dec 21, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 305300 CA Primary

Addresses

Primary practice location

2010 Wilshire Blvd
Santa Monica, CA 90403-5608

Mailing address

2010 Wilshire Blvd
Santa Monica, CA 90403-5608
Phone (310) 878-2540

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240124003283 CA Practitioner - Physical Therapist in Private Practice 7810340072 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sportsfit Physical Therapy CorporationGroup PAC ID 9739331109, 19 clinicians

Practice addresses (Care Compare)

2010 Wilshire Blvd
Santa Monica, CA 90403-5608
Phone (310) 878-2540

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
305300CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sportsfit Physical Therapy Corporation Physical Therapist CurrentSince Dec 11, 2023 Accepting new patients

Locations

4702 Lincoln Blvd
Marina del Rey, CA 90292
Phone (310) 306-1478

2010 Wilshire Blvd
Santa Monica, CA 90403
Phone (310) 878-2540

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.

NPI Registry JSON

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

{
    "created_epoch": "1703116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1063281897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 WILSHIRE BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035608",
            "telephone_number": "310-878-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 WILSHIRE BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035608",
            "telephone_number": "310-878-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROVARNIK",
        "first_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-21",
        "last_updated": "2023-12-21",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "305300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.