Brian R Kosobucki, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

200401088 Issued in NC

Practice address

3333 Brookview Hills Blvd
Suite 107
Winston Salem, NC 27103-5661

Phone

(336) 842-3780

Fax

(336) 842-3964

NPI assigned

Sep 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Ophthalmology

Education

Wake Forest University School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
• Novant Health Medical Park Hospital Hospital, Winston-Salem, NC, CCN 340148

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bkosobucki@ctrcare.intellechartdirect.net

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.

• Central Triad Retina, PA

  • Ophthalmology Physician
  • Winston Salem, NC
  • NPI 1689048423
  Medicare reassignment NPD
• Carolina Retina and Vitreous Consultants, PA

  • Specialist
  • Charlotte, NC
  • NPI 1982813911
  NPD
• Wake Forest Health Network, LLC

  • Pediatrics Physician
  • Greensboro, NC
  • NPI 1053175299
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Forsyth Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233
  Care Compare affiliation
• Medical Park Hospital LLC

  • General Acute Care Hospital
  • Winston-Salem, NC
  • NPI 1538111828
  Care Compare affiliation

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705276800000",
    "number": "1366548174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 BROOKVIEW HILLS BLVD STE 107",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035661",
            "telephone_number": "336-970-5900",
            "fax_number": "336-842-3964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 BROOKVIEW HILLS BLVD",
            "address_2": "SUITE 107",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035661",
            "telephone_number": "336-842-3780",
            "fax_number": "336-842-3964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSOBUCKI",
        "first_name": "BRIAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2024-01-15",
        "certification_date": "2024-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "NC",
            "license": "200401088",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NC",
            "license": "200401088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "804621",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689048423",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "137HT",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "NCR000F360",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ivana Korankyi, PHARMACIST
• Aryn Elizabeth Kormanis, DO
• John Korona
• Bill Gus Kortesis, M.D.
• Carla Mann Koskinas, PA-C
• Kostelic & Associates 2, PLLC
• Phillip Martin Kostelic
• Paul J Kostuchenko, MD
• Shannon Kostuck, MSW, LCSW-A
• Joshua Kota

• Ophthalmology Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Ophthalmology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.