Shawna Koprucki, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35.097076 Issued in OH

Practice address

4694 Belmont Ave
Youngstown, OH 44505-1012

Phone

(330) 480-7655

Fax

(330) 759-3851

NPI assigned

Nov 7, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Shawna Bouwers Former name

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Family Practice

Education

University of Pittsburgh School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Health Physicians Youngstown, LLCGroup PAC ID 9234318270, 116 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HMHP St Elizabeth Boardman Health Center Hospital, Boardman, OH, CCN 360276
• MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: skoprucki62769@direct.bsmhealth.org

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.

• Mercy Health Physicians Youngstown, LLC

  • Family Medicine Physician
  • Youngstown, OH
  • NPI 1154636066
  Medicare reassignment Care Compare group NPD
• Mercy Health Physicians Youngstown LLC

  • Durable Medical Equipment & Medical Supplies
  • Boardman, OH
  • NPI 1750920245
  NPD
• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1790868982
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1548296106
  Care Compare affiliation
• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1790868982
  Care Compare affiliation
• Mercy Health Youngstown LLC

  • Clinical Medical Laboratory
  • Youngstown, OH
  • NPI 1831600295

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1226016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482883200000",
    "number": "1093969735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4694 BELMONT AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051012",
            "telephone_number": "330-480-7655",
            "fax_number": "330-759-3851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4694 BELMONT AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051012",
            "telephone_number": "330-480-7655",
            "fax_number": "330-759-3851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPRUCKI",
        "first_name": "SHAWNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-07",
        "last_updated": "2016-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD441533",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.097076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056982",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "H245561",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHAWNA",
            "last_name": "BOUWERS",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jason Andrew Komsa
• Lisa M Koniowsky, PHYSICAL THERAPIST
• Ali Kooshkabadi, MD
• Adam Paul Kopacz, CRNA
• Michael Carl Koprucki, MD
• Marqus Koranteng, B.A., R.B.T,
• Lashara Marie Kornegay, LPN
• Phyllis Korpi, LPCC
• Kolin Korth, DO
• Jacqueline C Kosek

• Family Medicine Physician in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; 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.
• 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.