NPIMap

Individual provider Active NPI

Michal Kozanek, MD, PHD

  • Orthopaedic Surgery Physician
  • Woburn, MA
National Provider Identifier
1386937001
Registry record updated May 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
2020-01441 Issued in NC
Practice address
200 Unicorn Park Dr Ste 201
Woburn, MA 01801-3342
Phone
(781) 782-1300
Fax
(781) 782-1350
NPI assigned
May 27, 2011
Last updated
May 8, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 72171 WI
Orthopaedic Surgery Physician 207X00000X 2020-01441 NC Primary
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X 269712 MA

Addresses

Primary practice location

200 Unicorn Park Dr Ste 201
Woburn, MA 01801-3342

Mailing address

200 Unicorn Park Dr Ste 201
Woburn, MA 01801-3342
Phone (781) 782-1300

Other practice location 1

820 E Grant St
Appleton, WI 54911-3483
Phone (920) 831-5050

Other practice location 2

4140 Ferncreek Dr Ste 801
Fayetteville, NC 28314-2572
Phone (910) 848-2171

Other identifiers 1

IdentifierTypeStateIssuer
FK6059554OtherNCORTHOPEDICS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WI, NC3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20170113000029 TX Practitioner - Orthopedic Surgery 8022275387 Reassigns benefits to 1 organization
I20190703001385 WI Practitioner - Orthopedic Surgery 8022275387 Reassigns benefits to 1 organization
I20200803001500 NC Practitioner - Orthopedic Surgery 8022275387 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

820 E Grant St
Appleton, WI 54911-3483
Phone (920) 831-1841

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue1-10
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2020-01441NCMDOrthopaedic Surgery Physician
72171WIMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Oct 19, 2016 Accepting new patients
Cape Fear Orthopaedic Clinic, PA Orthopaedic Surgery CurrentSince Sep 1, 2020 Accepting new patients
Thedacare, Incorporated CurrentSince Jul 1, 2019 Accepting new patients
Healthtexas Provider Network CurrentSince Oct 19, 2016 Accepting new patients
Cape Fear Orthopaedic Clinic, P.a. Orthopaedic Surgery CurrentSince Sep 1, 2020 Accepting new patients
Thedacare Medical Center - Shawano, Inc. Past Accepting new patients

Locations

4140 Ferncreek Dr
Ste 801
Fayetteville, NC 28314
Phone (910) 484-2171

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

8080 N Central Expy
Ste 600
Dallas, TX 75206
Phone (469) 800-8648

5236 W University Dr
Ste 1500
McKinney, TX 75071
Phone (469) 764-2273

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

2400 E Capitol Dr
Appleton, WI 54911
Phone (920) 731-4101

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

1516 S Commercial St
Neenah, WI 54956
Phone (920) 725-0077

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: michal.kozanek.p1@direct.capefearortho.nextgenshare.com
  • Direct secure messaging: mkozanek274526@direct.thedacare.org

Organizations & group practices 6

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1306454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588896000000",
    "number": "1386937001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 UNICORN PARK DR STE 201",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018013342",
            "telephone_number": "781-782-1300",
            "fax_number": "781-782-1350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UNICORN PARK DR STE 201",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018013342",
            "telephone_number": "781-782-1300",
            "fax_number": "781-782-1350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "820 E Grant St",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549113483",
            "country_code": "US",
            "telephone_number": "920-831-5050",
            "fax_number": "920-738-6400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4140 Ferncreek Dr Ste 801",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283142572",
            "country_code": "US",
            "telephone_number": "910-848-2171",
            "fax_number": "910-484-4568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOZANEK",
        "first_name": "MICHAL",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-27",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "72171",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NC",
            "license": "2020-01441",
            "primary": true
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "MA",
            "license": "269712",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORTHOPEDICS",
            "identifier": "FK6059554",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woburn, MA

Sources for this page

Verify at the official NPI Registry.