NPIMap

Individual provider Active NPI

Thomas E. Czajkowski, M.D.

  • Emergency Medicine Physician
  • Boston, MA
National Provider Identifier
1710220595
Registry record updated May 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DR.0058342 Issued in CO
Practice address
1 Boston Medical Ctr PL
Dowling 1 South, Room 1322
Boston, MA 02118-2908
Phone
(617) 414-5481
NPI assigned
Mar 31, 2013
Last updated
May 4, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 1710220595 MA
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X DR.0058342 CO Primary

Addresses

Primary practice location

1 Boston Medical Ctr PL
Dowling 1 South, Room 1322
Boston, MA 02118-2908

Mailing address

1 Boston Medical Ctr PL
Dowling 1 South, Room 1322
Boston, MA 02118-2908

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rmc@direct.slvrmc.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, WA, AZ3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20170720001767 CO Practitioner - Emergency Medicine 5698907939 Reassigns benefits to 2 organizations
I20230925001231 WA Practitioner - Emergency Medicine 5698907939 Reassigns benefits to 2 organizations
I20231218001940 AZ Practitioner - Emergency Medicine 5698907939 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tri-State Memorial HospitalGroup PAC ID 4082502422, 33 clinicians

Practice addresses (Care Compare)

1221 Highland Ave
Clarkston, WA 99403-2829
Phone (509) 758-5511

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1710220595MAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Innova Emergency Medical Associates PC Emergency Medicine CurrentSince Aug 1, 2018 Accepting new patients
Tri-State Memorial Hospital Current Accepting new patients
Community Hospital Association, Inc. CurrentSince Oct 3, 2023 Accepting new patients
Tri-State Memorial Hospital CurrentSince Sep 1, 2023 Accepting new patients
Community Hospital Association, Inc. CurrentSince Oct 3, 2023 Accepting new patients
Tri-State Memorial Hospital CurrentSince Sep 1, 2023 Accepting new patients
Tri-State Memorial Hospital Past Accepting new patients

Locations

520 Rose Ln
Wickenburg, AZ 85390
Phone (928) 666-1197

410 Benedicta Ave
Trinidad, CO 81082
Phone (719) 846-8051

1221 Highland Ave
Clarkston, WA 99403
Phone (509) 751-0312

Organizations & group practices 9

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 3

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": "1364688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1710220595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BOSTON MEDICAL CTR PL",
            "address_2": "DOWLING 1 SOUTH, ROOM 1322",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BOSTON MEDICAL CTR PL",
            "address_2": "DOWLING 1 SOUTH, ROOM 1322",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182908",
            "telephone_number": "617-414-5481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CZAJKOWSKI",
        "first_name": "THOMAS",
        "middle_name": "E.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-31",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "1710220595",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "DR.0058342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rmc@direct.slvrmc.org",
            "affiliation": "N",
            "endpointDescription": "San Luis Valley Health ED Thomas Czajkowski",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "106 Blanca Ave",
            "city": "Alamosa",
            "state": "CO",
            "country_code": "US",
            "postal_code": "811012340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.