Michael John Borucki, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G6777 Issued in TX

Practice address

1600 Providence Dr
Family Practice Center
Waco, TX 76707-2261

Phone

(254) 750-8200

Fax

(254) 750-8383

NPI assigned

Oct 12, 2005

Last updated

Jan 14, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358121600000",
    "number": "1194713230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "address_2": "FAMILY PRACTICE CENTER",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-750-8200",
            "fax_number": "254-750-8383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "address_2": "FAMILY PRACTICE CENTER",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-750-8200",
            "fax_number": "254-750-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORUCKI",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2013-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "G6777",
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "TX",
            "license": "G6777",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122949405",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TPI-TEXAS PROVIDER ID",
            "identifier": "756.061.354",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Waco, TX
• Providers in Waco, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.