NPIMap

Individual provider Active NPI

Nikita V. Bezrukov, M.D.

  • Orthopaedic Surgery Physician
  • Orange, CA
National Provider Identifier
1770737017
Registry record updated Feb 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
A111624 Issued in CA
Practice address
1310 W Stewart Dr Ste 410
Orange, CA 92868-3855
Phone
(714) 538-8549
Fax
(714) 538-1547
NPI assigned
Nov 13, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X MD-17786 HI
Orthopaedic Surgery Physician 207X00000X A111624 CA Primary

Addresses

Primary practice location

1310 W Stewart Dr Ste 410
Orange, CA 92868-3855

Mailing address

2180 Main St
Wailuku, HI 96793-1625
Phone (808) 242-6464

Other names 1

  • Nikita Bezrukiy Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131122000706 CA Practitioner - Orthopedic Surgery 0648406678 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orange Orthopedic Medica GP Inc the Providence BLDGGroup PAC ID 2961441852, 10 clinicians

Practice addresses (Care Compare)

1310 W Stewart Dr
Suite 410
Orange, CA 92868-3855
Phone 7145388549103

Hospital & facility affiliations

  • Grandcare Home Health Services Home health agency, Pasadena, CA, CCN 058277
  • N & D Healthcare Services Inc Home health agency, Pasadena, CA, CCN 058255
  • Providence St. Joseph Hospital Hospital, Orange, CA, CCN 050069
  • Providence St. Jude Medical Center Hospital, Fullerton, CA, CCN 050168

Merit-based Incentive Payment System (MIPS)

Final score
82.89 of 100Reported as group
Quality
79.31
Promoting interoperability
87
Improvement activities
40
Cost
72.2

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement23
Knee replacement18
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
111624CAMDMarriage & Family Therapist
A111624CAMDOrthopaedic Surgery Physician
MD-17786HIMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orange Orthopedic Medica GP, Inc. the Providence BLDG Orthopaedic Surgery CurrentSince Oct 1, 2017 Accepting new patients
Regents of the University of California Orthopaedic Surgery CurrentSince Oct 4, 2016 Accepting new patients
Regents of the University of California CurrentSince Oct 4, 2016 Accepting new patients
Maui Memorial Medical Center Past Accepting new patients
Regents of the University of California Past Accepting new patients

Locations

1310 W Stewart Dr
Ste 410
Orange, CA 92868
Phone (714) 538-8549

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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 6

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": "1226534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517443200000",
    "number": "1770737017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 MAIN ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967931625",
            "telephone_number": "808-242-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 W STEWART DR STE 410",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683855",
            "telephone_number": "714-538-8549",
            "fax_number": "714-538-1547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEZRUKOV",
        "first_name": "NIKITA",
        "middle_name": "V.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-13",
        "last_updated": "2018-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "HI",
            "license": "MD-17786",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A111624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NIKITA",
            "last_name": "BEZRUKIY",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.