Active NPI
Louis John Borucki, MD
- Nephrology Physician
- West Palm Beach, FL
National Provider Identifier
1235100298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- ME29203
- Practice address
- 1411 N Flagler Drive
Ste 8000
West Palm Beach, FL 33401 - Phone
- (561) 833-7600
- Fax
- (561) 833-7644
- NPI assigned
- Jan 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | ME29203 | FL | Primary |
Addresses
Primary practice location
1411 N Flagler Drive
Ste 8000
West Palm Beach, FL 33401
Mailing address
1411 N Flagler Drive
Ste 8000
West Palm Beach, FL 33401
Phone (561) 833-7600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036834200 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME29203 | FL | MD | Nephrology Physician |
| 29203 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clarksdale Hma Physician Management LLC | Nephrology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Clarksdale, MS
- NPI 1740297688
Nephrology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333929600000",
"number": "1235100298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1411 N FLAGLER DRIVE",
"address_2": "STE 8000",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "33401",
"telephone_number": "561-833-7600",
"fax_number": "561-833-7644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 N FLAGLER DRIVE",
"address_2": "STE 8000",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "33401",
"telephone_number": "561-833-7600",
"fax_number": "561-833-7644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORUCKI",
"first_name": "LOUIS",
"middle_name": "JOHN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-30",
"last_updated": "2012-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "FL",
"license": "ME29203",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036834200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Palm Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.