NPIMap

Organization Active NPI

PBGS, LLC

  • Ambulatory Surgical Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1164848453
Registry record updated Nov 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PBGS, LLC
Practice address
14 Dekalb Ave
4TH Floor
Brooklyn, NY 11201-5311
Phone
(718) 408-4999
NPI assigned
Mar 11, 2014
Last updated
Nov 15, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2015

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

Authorized official

Name
Dmitriy Bronfman, MDNPI 1811060643
Title
Medical Director
Phone
(718) 408-4999

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
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

14 Dekalb Ave
4TH Floor
Brooklyn, NY 11201-5311

Mailing address

14 Dekalb Ave
4TH Floor
Brooklyn, NY 11201-5311
Phone (718) 408-4999

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141112000396 NY Part B Supplier - Ambulatory Surgical Center 9436371259 Receives reassigned benefits from 11 practitioners
Practice locations: Brooklyn, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164848453. Details of each certification follow.

Ambulatory surgical center certification: CCN 33C0001151

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PBGS, LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Dec 26, 2014
Last certification
Dec 26, 2014
Ownership / control type
Proprietary
Facility address
14 Dekalb Avenue Brooklyn
Brooklyn, NY 11201

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2078627PBGS LLC14 Dekalb Ave - 4TH Floor, Brooklyn, NY 11201Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Locations

14 DeKalb Ave
Brooklyn, NY 11201
Phone (718) 875-4848

14 DeKalb Ave
#4
Brooklyn, NY 11201
Phone (718) 875-4848

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447545600000",
    "number": "1164848453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 DEKALB AVE",
            "address_2": "4TH FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015311",
            "telephone_number": "718-408-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 DEKALB AVE",
            "address_2": "4TH FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015311",
            "telephone_number": "718-408-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PBGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-11",
        "last_updated": "2015-11-15",
        "status": "A",
        "authorized_official_last_name": "BRONFMAN",
        "authorized_official_first_name": "DMITRIY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "718-408-4999",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.