Daniel W Zajicek, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

581 Issued in WI

Practice address

1611 S Madison St
Appleton, WI 54915-1844

Phone

(920) 730-6700

NPI assigned

Sep 28, 2005

Last updated

Dec 11, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1127865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1437146198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 S MADISON ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151844",
            "telephone_number": "920-730-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 S MADISON ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151844",
            "telephone_number": "920-730-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZAJICEK",
        "first_name": "DANIEL",
        "middle_name": "W",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-28",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42928200",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "daniel.zajicek.1@10114.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "1501 S Madison St",
            "city": "Appleton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549151846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Darrell M Yunk
• Brianne Zaborowske, LCSW
• Douglas Randal Zabrowski, M.D.
• Nathan A Zachor, DC
• Amy Jo Zafarani, D.O.
• Ashley Zajkowski
• Shannon Zajkowski
• Mohamed Ragab Zakarya, M.D.
• Heather Anne Zalapa, HIS
• Christine M Zanotelli

• Physician Assistant in Appleton, WI
• Providers in Appleton, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.