Kyle James Borodunovich

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS17309 Issued in FL

Practice address

2812 54TH Ave S
St Petersburg, FL 33712-4610

Phone

(727) 867-8641

Fax

(727) 867-6795

NPI assigned

Apr 17, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Family Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Optumcare Florida, LLCGroup PAC ID 3072403476, 266 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Networks

• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: kyle.borodunovich@wellmed.eclinicaldirectplus.com

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.

• Optumcare Florida LLC

  dba Optum

  • General Practice Physician
  • Tampa, FL
  • NPI 1053384214

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Optumcare Florida, LLC

  dba Optum

  • Hospitalist Physician
  • Tampa, FL
  • NPI 1659884294
  NPD
• Landmark Medical of Florida, PA

  • General Practice Physician
  • Tampa, FL
  • NPI 1639888571
  NPD (past)
• Optumcare Florida Ci, LLC

  • Primary Care Clinic/Center
  • Winter Park, FL
  • NPI 1720506603
  NPD (past)

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1396232229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5130 SUNFOREST DR STE 300",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336346327",
            "telephone_number": "727-824-0780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2812 54TH AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337124610",
            "telephone_number": "727-867-8641",
            "fax_number": "727-867-6795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORODUNOVICH",
        "first_name": "KYLE",
        "middle_name": "JAMES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-17",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS17309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "OS17309",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Borders, MBA, RD, LD/N
• Holly Suzanne Bordon, M.D.
• Kenny Borgas
• Christina Borghi
• Elena Borisenko, ARNP
• Rosemary C Borzell, M.A. CCC-SLP
• Loan Bosch, FNP-C
• Kara Boskee, B.S., M.S.
• Shawniece Devon Boss, DPM
• Carli Bostic-Bixby

• Family Medicine Physician in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; 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.