Individual provider Active NPI

Jordan Atanasov Kazakov, MD

  • Pulmonary Disease Physician
  • Cleveland, OH
National Provider Identifier
1144523630
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
FK4226595 Issued in OH
Practice address
11100 Euclid Ave # Bolwell 6
Cleveland, OH 44106-1716
Phone
(216) 844-1722
NPI assigned
Dec 6, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 330879 LA
Pulmonary Disease Physician 207RP1001X FK4226595 OH Primary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 330879 LA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X FK4226595 OH
Pulmonary Disease Physician 207RP1001X 330879 LA

Addresses

Primary practice location

11100 Euclid Ave # Bolwell 6
Cleveland, OH 44106-1716

Mailing address

1401 Prospect Ave E Apt 805
Cleveland, OH 44115-2349
Phone (843) 902-7253

Other practice location 1

2647 S Saint Elizabeth Blvd Ste 215
Gonzales, LA 70737-5020
Phone (225) 765-5500

Other practice location 2

309 Jackson St
Monroe, LA 71201-7407
Phone (318) 966-4541

Other practice location 3

7777 Hennessy Blvd Ste 701
Baton Rouge, LA 70808-4370
Phone (225) 765-5864

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jkazakov2493750@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, IL, NY3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20200109002084 RI Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 4587899257 Reassigns benefits to 1 organization
I20220816003879 IL Practitioner - Critical Care (Intensivists) 4587899257 Reassigns benefits to 1 organization
I20231013001998 NY Practitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 4587899257 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

100 E 77TH St
New York, NY 10075-1850
Phone (212) 434-2140

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
FK4226595OHMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Jul 1, 2022 Accepting new patients
Prime Healthcare Services Landmark LLC CurrentSince Nov 2, 2019 Accepting new patients
Prime Healthcare Services Landmark LLC CurrentSince Nov 2, 2019 Accepting new patients
North Shore-Lij Medical PC Hospitalist CurrentSince Aug 21, 2023 Accepting new patients
Central Dupage Physician Group Hospitalist CurrentSince Jul 1, 2022 Accepting new patients
St Francis Medical Center, Inc Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

10400 Haligus Rd
Huntley, IL 60142
Phone (224) 654-0000

4201 W Medical Center Dr
McHenry, IL 60050
Phone (815) 759-3100

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

300 Community Dr
Plandome, NY 11030

115 Cass Ave
Woonsocket, RI 02895
Phone (401) 356-1701

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: jkazakov2493750@direct.casso.us.com
  • Direct secure messaging: jkazakov29871@tuftsmedicine.direct-ci.com
  • Direct secure messaging: jkazakov65919@northwell.direct-ci.com

Organizations & group practices 7

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 1

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": "1291593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1144523630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 PROSPECT AVE E APT 805",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441152349",
            "telephone_number": "843-902-7253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 EUCLID AVE # BOLWELL 6",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061716",
            "telephone_number": "216-844-1722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2647 S Saint Elizabeth Blvd Ste 215",
            "address_purpose": "LOCATION",
            "city": "Gonzales",
            "state": "LA",
            "postal_code": "707375020",
            "country_code": "US",
            "telephone_number": "225-765-5500",
            "fax_number": "225-644-4206",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "309 Jackson St",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712017407",
            "country_code": "US",
            "telephone_number": "318-966-4541",
            "fax_number": "318-966-4543",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7777 Hennessy Blvd Ste 701",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708084370",
            "country_code": "US",
            "telephone_number": "225-765-5864",
            "fax_number": "225-765-2013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAZAKOV",
        "first_name": "JORDAN",
        "middle_name": "ATANASOV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-06",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "LA",
            "license": "330879",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "OH",
            "license": "FK4226595",
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "LA",
            "license": "330879",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "OH",
            "license": "FK4226595",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "LA",
            "license": "330879",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkazakov2493750@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jkazakov2493750@direct.casso.us.com",
            "address_1": "309 Jackson St",
            "city": "Monroe",
            "state": "LA",
            "country_code": "US",
            "postal_code": "712017407",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "309 Jackson St",
            "city": "Monroe",
            "state": "LA",
            "country_code": "US",
            "postal_code": "712017407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.