NPIMap

Individual provider Active NPI

James Kenneth Dziadziola, MD

  • Otolaryngology Physician
  • Concord, NC
National Provider Identifier
1033108980
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
9700538 Issued in NC
Practice address
645 Amalia St NE
Concord, NC 28025-2434
Phone
(704) 295-3255
NPI assigned
Oct 13, 2005
Last updated
Sep 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 9700538 NC Primary

Addresses

Primary practice location

645 Amalia St NE
Concord, NC 28025-2434

Mailing address

645 Amalia St NE Ste 1
Concord, NC 28025-2434
Phone (704) 295-3255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20100805000186 NC Practitioner - Pediatric MedicinePractitioner - Otolaryngology 0446311633 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Otolaryngology
Education
Wayne State University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

645 Amalia St NE
Concord, NC 28025-2434
Phone (704) 295-3255

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Charlotte Eye Ear Nose & Throat Associates, P.a. Otolaryngology CurrentSince Apr 6, 2021 Accepting new patients
Charlotte Eye Ear Nose & Throat Associates, PA CurrentSince Apr 6, 2021 Accepting new patients

Locations

6035 Fairview Rd
Charlotte, NC 28210
Phone (336) 718-2078

645 Amalia St NE
Concord, NC 28025
Phone (704) 295-3255

645 Amalia St NE
Ste 1
Concord, NC 28025

10305 Hamptons Park Dr
Ste 201
Huntersville, NC 28078
Phone (704) 295-3600

Interoperability endpoints

  • Direct secure messaging: jdziadziola34845@direct.ceenta.com

Organizations & group practices 2

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 10

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": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1033108980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 AMALIA ST NE STE 1",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252434",
            "telephone_number": "704-295-3255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 AMALIA ST NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252434",
            "telephone_number": "704-295-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZIADZIOLA",
        "first_name": "JAMES",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "9700538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.