Thomas J Rozwadowski, M.D.
Individual provider Active NPI Emergency Medicine Physician · Ba, CA
NPI 1508917105 · NPPES record last updated Sep 22, 2009
Key facts
- NPI
- 1508917105
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- A104716 (CA)
- Practice address
- 555 7TH St
Ba, CA 93556-0808 - Phone
- (760) 957-3203
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Georgetown University School of Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Paragon Emergency Services LLC
Practice addresses (Care Compare)
611 Zeagler Dr
Palatka, FL 32177-3810
Phone (800) 424-3672
Hospital & facility affiliations
- HCA Florida Capital Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181214001338 | FL | Practitioner - Emergency Medicine | 9032277835 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A104716 | CA | MD | Emergency Medicine Physician |
| ME 100274 | FL | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Oliver Emergency Group, LLC | Emergency Medicine | Current | Accepting new patients |
| Lake Oliver Emergency Group, LLC | Emergency Medicine | Current |
Accepting new patients |
| Paragon Emergency Services LLC | Emergency Medicine | Current |
Accepting new patients |
| Lake Oliver Emergency Group, LLC | Emergency Medicine | Current |
Accepting new patients |
| Tidal Emergency Physicians LLC | Emergency Medicine | Past | Accepting new patients |
| Chase Dennis Emergency Medical Group Inc | Emergency Medicine | Past | Accepting new patients |
Locations
3625 University Blvd S
Jacksonville, FL 32216
Phone (904) 333-9404
611 Zeagler Dr
Palatka, FL 32177
Phone (386) 326-8070
23186 Blue Star Hwy
Quincy, FL 32351
Phone (850) 875-5977
2626 Capital Medical Blvd
Tallahassee, FL 32308
Phone (850) 325-5000
1451 El Camino Real
The Villages, FL 32159
Phone (352) 751-8000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | ME 100274 | FL | |
| Emergency Medicine Physician | 207P00000X | A104716 | CA | Yes |
Addresses
Primary practice location
555 7TH St
Ba, CA 93556-0808
Mailing address
1905 Blue Ridge Rd
Ridgecrest, CA 93555-2703
Phone (904) 327-7121
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.