Individual provider Active NPI

Lubomyr Boris, D.O.

  • Surgery Physician
  • Pittsburgh, PA
National Provider Identifier
1205368115
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
OS022193 Issued in PA
Practice address
4815 Liberty Ave Ste 439
Pittsburgh, PA 15224-2156
Phone
(724) 260-7300
NPI assigned
Mar 30, 2017
Last updated
Sep 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036163845 IL
Surgery Physician 208600000X OS022193 PA Primary

Addresses

Primary practice location

4815 Liberty Ave Ste 439
Pittsburgh, PA 15224-2156

Mailing address

4815 Liberty Ave Ste 439
Pittsburgh, PA 15224-2156
Phone (724) 260-7300

Other practice location 1

3700 W 203rd St Ste 201
Olympia Fields, IL 60461-1182
Phone (708) 852-2780

Other identifiers 1

IdentifierTypeStateIssuer
15666772OtherCAQH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lboris219552@Direct.FranciscanAlliance.org Direct

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20230818000223 IL Practitioner - General Surgery 2668743337 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Marian University College of Osteopathic Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3700 W 203Rd St
Suite 201
Olympia Fields, IL 60461-1182
Phone (708) 679-2880

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux53
Removal of tissue23
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036163845ILMDSurgery Physician
OS022193PAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Specialty Physicians of Illinois, LLC Surgery Current Accepting new patients
Specialty Physicians of Illinois, LLC CurrentSince Aug 27, 2023 Accepting new patients

Locations

35318 Eagle Way
Chicago, IL 60678

3700 W 203rd St
Ste 201A
Olympia Fields, IL 60461

3700 W 203rd St
Ste 201
Olympia Flds, IL 60461
Phone (708) 679-2880

3700 W 203rd St
Ste 301
Olympia Flds, IL 60461
Phone (708) 679-2850

Interoperability endpoints

  • Direct secure messaging: lboris219552@direct.franciscanalliance.org

Organizations & group practices 3

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 2

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": "1490832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1205368115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4815 LIBERTY AVE STE 439",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152242156",
            "telephone_number": "724-260-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4815 LIBERTY AVE STE 439",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152242156",
            "telephone_number": "724-260-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3700 W 203rd St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Olympia Fields",
            "state": "IL",
            "postal_code": "604611182",
            "country_code": "US",
            "telephone_number": "708-852-2780",
            "fax_number": "708-503-3230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORIS",
        "first_name": "LUBOMYR",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-30",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036163845",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "OS022193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "15666772",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lboris219552@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3700 W 203rd St Ste 201",
            "city": "Olympia Fields",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604611182",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pittsburgh, PA

Sources for this page

Verify at the official NPI Registry.