Individual provider Active NPI

Jason Keith Klopotowski, MD

  • Anesthesiology Physician
  • Charlotte, NC
National Provider Identifier
1619097920
Registry record updated Mar 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
2014-01583 Issued in NC
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

Updated by the provider on Mar 5, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
K269430-KOHMGOtherKYKY MEDICARE
7100580170MedicaidKY
300022326MedicaidIN

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

LicenseStateTypeSpecialty
52126KYMDAnesthesiology Physician
2014-01583NCMDAnesthesiology 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.

Verify at the official NPI Registry.