NPIMap

Individual provider Active NPI

Zdenko Slobodnik, M.D.

  • Anesthesiology Physician
  • Jackson, MS
National Provider Identifier
1073527941
Registry record updated Jan 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
15013 Issued in MS
Practice address
2500 North State Street
Jackson, MS 39216-4500
Phone
(601) 815-1196
Fax
(601) 984-5939
NPI assigned
Jul 28, 2006
Last updated
Jan 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2016

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 15013 MS Primary
Anesthesiology Physician 207L00000X A60753 CA
Anesthesiology Physician 207L00000X MD057511L PA
Anesthesiology Physician 207L00000X MD0000028302 TN

Addresses

Primary practice location

2500 North State Street
Jackson, MS 39216-4500

Mailing address

2500 North State Street
JMM Room 2525
Jackson, MS 39216-4500
Phone (601) 984-6426

Other identifiers 1

IdentifierTypeStateIssuer
0032844MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A60753CAMDAnesthesiology Physician
MD0000028302TNMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Amory Hma Physician Management LLC Anesthesiology Past Accepting new patients
Mercy Tyler Hospital Past Accepting new patients
Mercy Tyler Health Systems Past Accepting new patients

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452643200000",
    "number": "1073527941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NORTH STATE STREET",
            "address_2": "JMM ROOM 2525",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-6426",
            "fax_number": "601-984-6439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NORTH STATE STREET",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-1196",
            "fax_number": "601-984-5939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLOBODNIK",
        "first_name": "ZDENKO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2016-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MS",
            "license": "15013",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A60753",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD057511L",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "MD0000028302",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0032844",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.