Individual provider Active NPI

Robert Mark Boguski, DPM

  • Podiatrist
  • Roanoke, VA
National Provider Identifier
1770143919
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
5951001235 Issued in MI
Practice address
222 Walnut Ave SW
Roanoke, VA 24016-4723
Phone
(947) 521-1320
NPI assigned
Jun 19, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 5951001235 MI Primary

Addresses

Primary practice location

222 Walnut Ave SW
Roanoke, VA 24016-4723

Mailing address

28050 Grand River Ave
Farmington Hills, MI 48336-5919
Phone (947) 521-1320

Other practice location 1

1802 Braeburn Dr Ste A2130
Salem, VA 24153-7357
Phone (540) 344-3668

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230531000348 MI Practitioner - Podiatry 8325372824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Kent State University College of Podiatric Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Foot and Ankle Specialists PCGroup PAC ID 1153363437, 4 clinicians

Practice addresses (Care Compare)

1042 N Monroe St
Monroe, MI 48162-3113
Phone (734) 241-0200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.02 of 100Reported as group
Quality
79.37
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue53
Removal of skin lesions64
Removal of nail tissue319

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Foot and Ankle Specialists PC Podiatrist CurrentSince Jul 1, 2023 Accepting new patients
Foot and Ankle Specialists PC Podiatrist CurrentSince Jul 1, 2023 Accepting new patients
Huron Valley Consultation Center Inc Past Accepting new patients

Locations

8085 Secor Rd
Lambertville, MI 48144
Phone (734) 856-8900

1042 N Monroe St
Monroe, MI 48162
Phone (734) 241-0200

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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": "1560902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1770143919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28050 GRAND RIVER AVE",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483365919",
            "telephone_number": "947-521-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 WALNUT AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164723",
            "telephone_number": "947-521-1320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1802 Braeburn Dr Ste A2130",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "VA",
            "postal_code": "241537357",
            "country_code": "US",
            "telephone_number": "540-344-3668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOGUSKI",
        "first_name": "ROBERT",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-19",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "5951001235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.