NPIMap

Individual provider Active NPI

Jordan Gozdzialski, M.D.

  • Anesthesiology Physician
  • Boulder, CO
National Provider Identifier
1083029011
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
DR.0062308 Issued in CO
Practice address
4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone
(303) 415-7000
NPI assigned
Jun 28, 2014
Last updated
Apr 13, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X DR.0062308 CO Primary
Anesthesiology Physician 207L00000X 30797 NE

Addresses

Primary practice location

4747 Arapahoe Ave
Boulder, CO 80303-1131

Mailing address

PO Box 17389
Denver, CO 80217-0389

Other practice location 1

Emile @ 42nd St
Omaha, NE 68198-4455
Phone (402) 559-4081

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20190618001834 CO Practitioner - AnesthesiologyPractitioner - Hospitalist 2466672878 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Hospitalist
Education
University of Wisconsin School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Valley Anesthesiology, PLLCGroup PAC ID 7113830993, 61 clinicians

Practice addresses (Care Compare)

4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 415-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0062308COMDAnesthesiology Physician
30797NEMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rocky Mountain State Anesthesia Providers Anesthesiology CurrentSince Aug 1, 2019 Accepting new patients
Rocky Mountain State Anesthesia Providers Anesthesiology CurrentSince Aug 1, 2019 Accepting new patients
Boulder Valley Anesthesiology, PLLC Anesthesiology CurrentSince Apr 15, 2022 Accepting new patients
Boulder Pain Institute, PC Anesthesiology PastSince Apr 17, 2022 Accepting new patients

Locations

1100 Balsam Ave
Boulder, CO 80304
Phone (303) 415-7000

4747 Arapahoe Ave
Boulder, CO 80303
Phone (303) 415-7000

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

5890 W 13th St
Ste 102
Greeley, CO 80634
Phone (970) 348-0090

10170 Church Ranch Way
Westminster, CO 80021
Phone (303) 328-3400

Organizations & group practices 4

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 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1403913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1083029011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17389",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802170389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 ARAPAHOE AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031131",
            "telephone_number": "303-415-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Emile @ 42nd St",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681984455",
            "country_code": "US",
            "telephone_number": "402-559-4081",
            "fax_number": "402-559-7372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOZDZIALSKI",
        "first_name": "JORDAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-28",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CO",
            "license": "DR.0062308",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NE",
            "license": "30797",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.