Active NPI
Courtney Dean Borruso, DO
- Internal Medicine Physician
- Ashtabula, OH
National Provider Identifier
1295990158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 34.011500
- Practice address
- 2131 Lake Ave Suite 4
Ashtabula, OH 44004 - Phone
- (440) 964-3733
- Fax
- (440) 964-7069
- NPI assigned
- Jul 21, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | OS015061 | PA | |
| Internal Medicine Physician | 207R00000X | 34.011500 | OH | Primary |
Addresses
Primary practice location
2131 Lake Ave Suite 4
Ashtabula, OH 44004
Mailing address
2131 Lake Ave. Suite 4
Ashtabula, OH 44004
Phone (440) 964-3733
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1024998940003 | Medicaid | PA | |
| 002518014 | Other | PA | HIGHMARK BCBS |
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 Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Erie Physicians Network PC | 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.
-
- Multi-Specialty Clinic/Center
- Erie, PA
- NPI 1902844574
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428624000000",
"number": "1295990158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2131 LAKE AVE. SUITE 4",
"city": "ASHTABULA",
"state": "OH",
"postal_code": "44004",
"telephone_number": "440-964-3733",
"fax_number": "440-964-7069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2131 LAKE AVE SUITE 4",
"city": "ASHTABULA",
"state": "OH",
"postal_code": "44004",
"telephone_number": "440-964-3733",
"fax_number": "440-964-7069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORRUSO",
"first_name": "COURTNEY",
"middle_name": "DEAN",
"name_prefix": "Mrs.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-21",
"last_updated": "2015-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "OS015061",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OH",
"license": "34.011500",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1024998940003",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BCBS",
"identifier": "002518014",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ashtabula, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.