NPIMap

Individual provider Active NPI

Maksim Boguslavskiy, DO

  • Surgical Critical Care Physician
  • East Stroudsburg, PA
National Provider Identifier
1821520107
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
OS023953 Issued in PA
Practice address
500 Plaza CT
East Stroudsburg, PA 18301-8262
Phone
(570) 426-2301
NPI assigned
Mar 28, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 73584 MN
Surgical Critical Care Physician 2086S0102X OS023953 PA Primary

Addresses

Primary practice location

500 Plaza CT
East Stroudsburg, PA 18301-8262

Mailing address

2100 Mack Blvd FL 4
Allentown, PA 18103-5622

Other practice location 1

24 Hospital Ave
Danbury, CT 06810-6099
Phone (203) 739-6013

Other practice location 2

200 1st St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mboguslavskiy1951367@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20240916003944 PA Practitioner - General Surgery 1355618927 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

1210 S Cedar Crest Blvd
Allentown, PA 18103-6235
Phone (610) 402-3888

200 E Brown St
LVPG Family Medicine Esu
East Stroudsburg, PA 18301-3006
Phone (272) 762-4378

5649 Wynnewood Dr
Laurys Station, PA 18059-1124

600 Commerce Blvd
Stroudsburg, PA 18360-6214
Phone (570) 424-7390

Hospital & facility affiliations

  • Lehigh Valley Home Care Home health agency, Allentown, PA, CCN 397023
  • Lehigh Valley Hospital - Pocono Hospital, East Stroudsburg, PA, CCN 390201
  • Lehigh Valley Hospital Hospital, Allentown, PA, CCN 390133

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue20

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS023953PAMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group CurrentSince Jan 1, 2025 Accepting new patients
Lehigh Valley Physician Group CurrentSince Jan 1, 2025 Accepting new patients
Family Care Centers Inc. Surgery CurrentSince Sep 30, 2024 Accepting new patients
Family Care Centers Inc CurrentSince Sep 30, 2024 Accepting new patients
Lehigh Valley Physician Group Surgery Current Accepting new patients
Lehigh Valley Hospital Pocono Past Accepting new patients

Locations

2100 Mack Blvd
Fl 4
Allentown, PA 18103

500 Plaza Ct
East Stroudsburg, PA 18301
Phone (570) 426-2330

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

320 W Pumping Station Rd
Quakertown, PA 18951
Phone (215) 529-4240

Interoperability endpoints

  • Direct secure messaging: mboguslavskiy1127722@direct2.lvhn.org

Organizations & group practices 10

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 7

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": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1821520107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 MACK BLVD FL 4",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181035622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PLAZA CT",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183018262",
            "telephone_number": "570-426-2301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Hospital Ave",
            "address_purpose": "LOCATION",
            "city": "Danbury",
            "state": "CT",
            "postal_code": "068106099",
            "country_code": "US",
            "telephone_number": "203-739-6013",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559050001",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOGUSLAVSKIY",
        "first_name": "MAKSIM",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-28",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "73584",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "PA",
            "license": "OS023953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mboguslavskiy1951367@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "200 1st St SW",
            "city": "Rochester",
            "state": "MN",
            "country_code": "US",
            "postal_code": "559050001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in East Stroudsburg, PA

Sources for this page

Verify at the official NPI Registry.