NPIMap

Individual provider Active NPI

Mikhail Mikhailovich Gorbounov, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Providence, RI
National Provider Identifier
1114410875
Registry record updated Jul 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
MD19925 Issued in RI
Practice address
593 Eddy St
Providence, RI 02903-4923
Phone
(401) 444-5057
Fax
(401) 606-1233
NPI assigned
Jun 7, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Pathology) Physician 207ZH0000X A-177937 CA
Molecular Genetic Pathology (Pathology) Physician 207ZP0007X A-177937 CA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD19925 RI Primary

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903-4923

Mailing address

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-5057

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240806003372 RI Practitioner - Pathology 4486909942 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Johns Hopkins University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Newport HospitalGroup PAC ID 0042111437, 42 clinicians
The Miriam HospitalGroup PAC ID 6901796408, 178 clinicians
Rhode Island HospitalGroup PAC ID 8921900044, 430 clinicians

Practice addresses (Care Compare)

11 Friendship St
Newport, RI 02840-2209
Phone (401) 845-1110

164 Summit Ave
Providence, RI 02906-2853
Phone (401) 793-7245

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-3777

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A-177937CAMDHematology (Pathology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rhode Island Hospital Hematology CurrentSince Aug 12, 2024 Accepting new patients
The Miriam Hospital Current Accepting new patients
Rhode Island Hospital CurrentSince Aug 12, 2024 Accepting new patients
Newport Hospital Anatomic Pathology & Clinical Pathology CurrentSince Aug 12, 2024 Accepting new patients
The Miriam Hospital CurrentSince Aug 12, 2024 Accepting new patients
Newport Hospital CurrentSince Aug 12, 2024 Accepting new patients
The Miriam Hospital Hematology CurrentSince Aug 12, 2024 Accepting new patients

Locations

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

11 Friendship St
Newport, RI 02840
Phone (401) 845-1110

164 Summit Ave
Ste C
Providence, RI 02906
Phone (401) 793-2931

593 Eddy St
Providence, RI 02903

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

593 Eddy St
Ste 9B
Providence, RI 02903
Phone (401) 444-5280

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1114410875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-5057",
            "fax_number": "401-606-1233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-5057",
            "fax_number": "401-606-1233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORBOUNOV",
        "first_name": "MIKHAIL",
        "middle_name": "MIKHAILOVICH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-07",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "CA",
            "license": "A-177937",
            "primary": false
        },
        {
            "code": "207ZP0007X",
            "taxonomy_group": "",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": "CA",
            "license": "A-177937",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "RI",
            "license": "MD19925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.