NPIMap

Individual provider Active NPI

Borislav Margaritov Mravkov, M.D.

  • Neurology Physician
  • Shallotte, NC
National Provider Identifier
1376680660
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
2008-01002 Issued in NC
Practice address
204 Smith Ave
Shallotte, NC 28470-4458
Phone
(910) 721-4220
Fax
(910) 721-4229
NPI assigned
Jan 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 72965 MN
Neurology Physician 2084N0400X 2008-01002 NC Primary
Neurology Physician 2084N0400X C2224 KY

Addresses

Primary practice location

204 Smith Ave
Shallotte, NC 28470-4458

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (910) 721-4220

Other practice location 1

1222 Medical Center Dr
Wilmington, NC 28401-7332
Phone (910) 341-3383

Other practice location 2

617 23rd St Ste 400
Ashland, KY 41101-2880
Phone (606) 408-2820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230112002839 MN Practitioner - Neurology 4385711316 Reassigns benefits to 1 organization
I20240215000942 KY Practitioner - Neurology 4385711316 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

Hospital & facility affiliations

  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036
  • Meeker Memorial Hospital Hospital, Litchfield, MN, CCN 241366
  • St Gabriels Hospital Hospital, Little Falls, MN, CCN 241370

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
72965MNMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Mar 2, 2024 Accepting new patients
Kings Daughters Medical Specialties Inc Current Accepting new patients
Kings Daughters Medical Specialties Inc CurrentSince Feb 5, 2024 Accepting new patients
Centracare Clinic Current Accepting new patients
Kings Daughters Medical Specialties Inc CurrentSince Feb 5, 2024 Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients
Wilmington Health PLLC Past Accepting new patients

Locations

2201 Lexington Ave
Ashland, KY 41101
Phone (606) 268-2560

617 23rd St
Ste 400
Ashland, KY 41101
Phone (606) 329-1770

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

Interoperability endpoints

  • Direct secure messaging: bmravkov804863@direct.centracare.com

Organizations & group practices 8

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.

Hospital & facility affiliations 12

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": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1376680660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "910-721-4220",
            "fax_number": "910-721-4229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 SMITH AVE",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284704458",
            "telephone_number": "910-721-4220",
            "fax_number": "910-721-4229"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1222 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284017332",
            "country_code": "US",
            "telephone_number": "910-341-3383",
            "fax_number": "910-341-3383",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "617 23rd St Ste 400",
            "address_purpose": "LOCATION",
            "city": "Ashland",
            "state": "KY",
            "postal_code": "411012880",
            "country_code": "US",
            "telephone_number": "606-408-2820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MRAVKOV",
        "first_name": "BORISLAV",
        "middle_name": "MARGARITOV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "72965",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NC",
            "license": "2008-01002",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "KY",
            "license": "C2224",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shallotte, NC

Sources for this page

Verify at the official NPI Registry.