Active NPI
Jason Keith Klopotowski, MD
- Anesthesiology Physician
- Charlotte, NC
National Provider Identifier
1619097920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 2014-01583
- Practice address
- 1000 Blythe Blvd
Charlotte, NC 28203-5812 - Phone
- (704) 377-5772
- NPI assigned
- Mar 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 52126 | KY | |
| Student in an Organized Health Care Education/Training Program | 390200000X | 4301087429 | MI | |
| Anesthesiology Physician | 207L00000X | 2014-01583 | NC | Primary |
Addresses
Primary practice location
1000 Blythe Blvd
Charlotte, NC 28203-5812
Mailing address
927 East Blvd
Charlotte, NC 28203-5203
Phone (704) 377-5772
Other practice location 1
200 Abraham Flexner Way
Louisville, KY 40202-2877
Phone (502) 587-4404
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| K269430-KOHMG | Other | KY | KY MEDICARE |
| 7100580170 | Medicaid | KY | |
| 300022326 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52126 | KY | MD | Anesthesiology Physician |
| 2014-01583 | NC | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551744000000",
"number": "1619097920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "927 EAST BLVD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282035203",
"telephone_number": "704-377-5772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 BLYTHE BLVD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282035812",
"telephone_number": "704-377-5772"
}
],
"practiceLocations": [
{
"address_1": "200 Abraham Flexner Way",
"address_purpose": "LOCATION",
"city": "Louisville",
"state": "KY",
"postal_code": "402022877",
"country_code": "US",
"telephone_number": "502-587-4404",
"fax_number": "502-587-4156",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KLOPOTOWSKI",
"first_name": "JASON",
"middle_name": "KEITH",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-30",
"last_updated": "2019-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "KY",
"license": "52126",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": "4301087429",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NC",
"license": "2014-01583",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KY MEDICARE",
"identifier": "K269430-KOHMG",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100580170",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300022326",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.