Gregory Paul Zydiak, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

R6E13 Issued in MO

Practice address

415 Oak Tree Dr
Webster Groves, MO 63119-4848

Phone

(314) 351-6189

Fax

(314) 968-4369

NPI assigned

Feb 27, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• New Haven Care Center, Inc

  • Skilled Nursing Facility
  • New Haven, MO
  • NPI 1760479125

  Adp of the SNF, Managing Control - Governing Body

  CMS ownership

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.

• New Haven Care Center, Inc

  • Skilled Nursing Facility
  • New Haven, MO
  • NPI 1760479125
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740317155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 OAK TREE DR",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631194848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 OAK TREE DR",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631194848",
            "telephone_number": "314-351-6189",
            "fax_number": "314-968-4369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZYDIAK",
        "first_name": "GREGORY",
        "middle_name": "PAUL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "R6E13",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karlye Wojton
• Kristin Wright, LMFT, PH.D.
• Reginald Joseph Wright
• Sean Wright, ATC
• Jay Zalis

• Internal Medicine Physician in Webster Groves, MO
• Providers in Webster Groves, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.