Active NPI
Miroslav Rafael Brzobohaty, DO
- Internal Medicine Physician
- Fort Myers, FL
National Provider Identifier
1407413636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- OS17489
- Practice address
- 9371 Cypress Lake Dr Ste 12
Fort Myers, FL 33919-4995 - Phone
- (239) 440-6456
- Fax
- (239) 236-0337
- NPI assigned
- May 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | OS17489 | FL | Primary |
Addresses
Primary practice location
9371 Cypress Lake Dr Ste 12
Fort Myers, FL 33919-4995
Mailing address
7031 SW 62ND Ave
South Miami, FL 33143-4701
Phone (305) 284-7761
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230504003279 | FL | Practitioner - Internal Medicine | 4385009828 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Touro Un College of Osteopathic Medicine, Vallejo, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gulf Shore Internal Medicine, P.a.
Practice addresses (Care Compare)
9371 Cypress Lake Dr
Suite 12
Fort Myers, FL 33919-4995
Phone 23944064566
Hospital & facility affiliations
- Lee Memorial Hospital
- Gulf Coast Medical Center Lee Health
- Cape Coral Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gulf Shore Internal Medicine, P.a. | Internal Medicine | Current | Accepting new patients |
Locations
9371 Cypress Lake Dr
Ste 12
Fort Myers, FL 33919
Phone (239) 440-6456
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.
-
- Internal Medicine Physician
- Fort Myers, FL
- NPI 1255501268
FL, Internal Medicine
Hospital & facility affiliations 3
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": "1558483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696291200000",
"number": "1407413636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7031 SW 62ND AVE",
"city": "SOUTH MIAMI",
"state": "FL",
"postal_code": "331434701",
"telephone_number": "305-284-7761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9371 CYPRESS LAKE DR STE 12",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339194995",
"telephone_number": "239-440-6456",
"fax_number": "239-236-0337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRZOBOHATY",
"first_name": "MIROSLAV",
"middle_name": "RAFAEL",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-22",
"last_updated": "2023-10-03",
"certification_date": "2023-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "OS17489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; 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.