NPIMap

Individual provider Active NPI

Jack Elias Kazanjian, D.O.

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Havertown, PA
National Provider Identifier
1407880032
Registry record updated Sep 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
OS010372L Issued in PA
Practice address
510 Darby Rd
Havertown, PA 19083-4630
Phone
(610) 449-6499
Fax
(610) 449-9814
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X OS010372L PA Primary

Addresses

Primary practice location

510 Darby Rd
Havertown, PA 19083-4630

Mailing address

510 Darby Rd
Havertown, PA 19083-4630
Phone (610) 449-6499

Other identifiers 1

IdentifierTypeStateIssuer
1018681980001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20040728000234 PA Practitioner - Orthopedic Surgery 9638082837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Philadelphia College of Osteopathic Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1396 Wilmington Pike
West Chester, PA 19382-8218
Phone (610) 399-1138

2004 Sproul Rd
FL 1
Broomall, PA 19008-3511
Phone (610) 353-0800

470 John Young Way
Suite 100
Exton, PA 19341-2557
Phone (610) 363-6589

525 W Chester Pike
Suite 101a
Havertown, PA 19083-4539
Phone (610) 449-2000

525 W Chester Pike
Suite 203
Havertown, PA 19083-4540
Phone (610) 789-7767

656 E Swedesford Rd
Suite 101
Wayne, PA 19087-1622
Phone (484) 768-9106

931 E Haverford Rd
Bryn Mawr, PA 19010-3838

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.6 of 100Reported as group
Promoting interoperability
96
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)51
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Orthopaedic and Sports Medicine Associates, LTD CurrentSince Apr 1, 2007 Accepting new patients
Premier Orthopaedic and Sports Medicine Associates LTD CurrentSince Apr 1, 2007 Accepting new patients
Hughston Clinic PC Adult Reconstructive Orthopaedic Surgery PastSince Jan 1, 1990 Accepting new patients
Hughston Clinic, P.C. PastSince Jan 1, 1990 Accepting new patients
Hughston Clinic, PC Adult Reconstructive Orthopaedic Surgery PastSince Jan 1, 1990 Accepting new patients
Orthopedic Sports & Arthritis Surgery Past Accepting new patients
Hughston Clinic, P.C. Adult Reconstructive Orthopaedic Surgery PastSince Jan 1, 1990 Accepting new patients

Locations

2004 Sproul Rd
Fl 1
Broomall, PA 19008
Phone (610) 353-0800

525 W Chester Pike
Ste 203
Havertown, PA 19083
Phone (610) 789-1425

510 Darby Rd
Havertown, PA 19083
Phone (610) 449-6499

510 Darby Rd
Ste 1
Havertown, PA 19083
Phone (610) 449-6499

Interoperability endpoints

  • Direct secure messaging: jack.kazanjian.1@22724.direct.athenahealth.com
  • Direct secure messaging: jackkazanjian@po.allscriptsdirect.net

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 6

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": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188950400000",
    "number": "1407880032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 DARBY RD",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190834630",
            "telephone_number": "610-449-6499",
            "fax_number": "610-449-9814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 DARBY RD",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190834630",
            "telephone_number": "610-449-6499",
            "fax_number": "610-449-9814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAZANJIAN",
        "first_name": "JACK",
        "middle_name": "ELIAS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2007-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "PA",
            "license": "OS010372L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1018681980001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Havertown, PA

Sources for this page

Verify at the official NPI Registry.