Individual provider Active NPI

Courtney Bogunovic, DPM

  • Podiatrist
  • Daytona Beach, FL
National Provider Identifier
1396992715
Registry record updated Mar 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO3487 Issued in FL
Practice address
1890 Lpga Blvd Ste 230
Daytona Beach, FL 32117-7131
Phone
(386) 274-3336
NPI assigned
Aug 27, 2008
Last updated
Mar 8, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X PO3487 FL Primary

Addresses

Primary practice location

1890 Lpga Blvd Ste 230
Daytona Beach, FL 32117-7131

Mailing address

1890 Lpga Blvd Ste 230
Daytona Beach, FL 32117-7131
Phone (386) 274-3336

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)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Practice roles

OrganizationSpecialtyStatusNew patients
Atlantic Podiatry Associates DPM PA CurrentSince Aug 14, 2019 Accepting new patients
Premier Foot and Ankle Clinic LLC Podiatrist CurrentSince May 15, 2013 Accepting new patients
Courtney C. Watkins Podiatrist PastSince Oct 1, 2011 Accepting new patients
Barry M Moskowitz DPM PC Podiatrist PastSince May 15, 2013 Accepting new patients

Locations

1890 Lpga Blvd
Ste 230
Daytona Beach, FL 32117
Phone (386) 274-3336

18525 W Dixie Hwy
Miami, FL 33180
Phone (305) 935-0503

11 Florida Park Dr N
Palm Coast, FL 32137
Phone (386) 251-5509

922 E Call St
Starke, FL 32091
Phone (904) 368-2300

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583625600000",
    "number": "1396992715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD STE 230",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177131",
            "telephone_number": "386-274-3336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD STE 230",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177131",
            "telephone_number": "386-274-3336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGUNOVIC",
        "first_name": "COURTNEY",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-27",
        "last_updated": "2020-03-08",
        "certification_date": "2020-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PO3487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.