Krzysztof Hendryk Ziola, MD
Individual provider Active NPI Internal Medicine Physician · Mountain Home, ID
NPI 1073692166 · NPPES record last updated Dec 16, 2016
Key facts
- NPI
- 1073692166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- M-10666 (ID)
- Practice address
- 2280 American Legion Blvd.
Mountain Home, ID 83647 - Phone
- (208) 587-3988
- Fax
- (208) 587-3324
- NPI assigned
- Nov 2, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101122000932 | ID | Practitioner - Internal Medicine | 2961464987 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A62465 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Glenns Ferry Health Center, Inc. | Current |
Accepting new patients | |
| Glenns Ferry Health Center, Inc. | Current | Accepting new patients | |
| Glenns Ferry Health Center, Inc. | Current |
Accepting new patients |
Locations
486 W 1st Ave
Glenns Ferry, ID 83623
Phone (208) 366-7416
2280 American Legion Blvd
Mt Home, ID 83647
Phone (208) 366-7416
Interoperability endpoints
- https://api.platform.athenahealth.com/16522/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | A62465 | CA | |
| Internal Medicine Physician | 207R00000X | M-10666 | ID | Yes |
Addresses
Primary practice location
2280 American Legion Blvd.
Mountain Home, ID 83647
Mailing address
2280 American Legion Blvd.
Mountain Home, ID 83647
Phone (208) 587-3988
Other names
- Christopher H Ziola
Other providers in Mountain Home, ID
All providers in Mountain Home, ID · Internal Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.