NPIMap

Individual provider Active NPI

Edward D Zdobylak, M.D.

  • Neurology Physician
  • Elk City, OK
National Provider Identifier
1558384545
Registry record updated May 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
01051068A Issued in IN
Practice address
1901 W 3Rd
Suitea
Elk City, OK 73644-7364
Phone
(580) 225-2513
Fax
(580) 303-5863
NPI assigned
Jul 25, 2006
Last updated
May 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 01051068A IN Primary

Addresses

Primary practice location

1901 W 3Rd
Suitea
Elk City, OK 73644-7364

Mailing address

PO Box 2339
Elk City, OK 73648-2339
Phone (805) 225-2513

Other identifiers 2

IdentifierTypeStateIssuer
000000939921OtherINANTHEM LEGACY #
200377800MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20230201000771 OK Practitioner - Neurology 3072588961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Indiana University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1800 W 1St St
Elk City, OK 73644-3133

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Farmers Union Hospital Association CurrentSince Dec 19, 2022 Accepting new patients
Farmers Union Hospital Association CurrentSince Dec 19, 2022 Accepting new patients
Advanced Migraine Care, P.C. Neurology CurrentSince Jan 1, 2008 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Major Hospital Past Accepting new patients
Rush Memorial Hospital Past Accepting new patients

Locations

13430 N Meridian St
Ste 165
Carmel, IN 46032
Phone (317) 582-8270

1800 W 1st St
Ste 3
Elk City, OK 73644
Phone (580) 225-4699

1801 W 3rd St
Elk City, OK 73644
Phone 40584358551407

1901 W 3rd St
Elk City, OK 73644
Phone (580) 225-1086

1901 W 3rd St
Ste A
Elk City, OK 73644
Phone (580) 225-2513

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 4

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683072000000",
    "number": "1558384545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2339",
            "city": "ELK CITY",
            "state": "OK",
            "postal_code": "736482339",
            "telephone_number": "805-225-2513",
            "fax_number": "580-303-5863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 W 3RD",
            "address_2": "SUITEA",
            "city": "ELK CITY",
            "state": "OK",
            "postal_code": "736447364",
            "telephone_number": "580-225-2513",
            "fax_number": "580-303-5863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZDOBYLAK",
        "first_name": "EDWARD",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2023-05-03",
        "certification_date": "2023-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "01051068A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM LEGACY #",
            "identifier": "000000939921",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200377800",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk City, OK

Sources for this page

Verify at the official NPI Registry.