NPIMap

Individual provider Active NPI

Jan Pawel Skowronski, M.D.

  • Interventional Cardiology Physician
  • Rockford, IL
National Provider Identifier
1790710283
Registry record updated Jan 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
36112374 Issued in IL
Practice address
444 Roxbury Road
Rockford, IL 61107-5059
Phone
(815) 398-3000
Fax
(815) 398-3041
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Health Centers LLC 184 clinicians

Practice addresses (Care Compare)

3980 Colonnade Pkwy
Birmingham, AL 35243-2382
Phone (205) 795-5390

Hospital & facility affiliations

  • Baptist Health Brookwood Hospital Hospital, Birmingham, AL, CCN 010139
  • Grandview Medical Center Hospital, Birmingham, AL, CCN 010104
  • Coosa Valley Medical Center Hospital, Sylacauga, AL, CCN 010164
  • Citizens Baptist Medical Center Hospital, Talladega, AL, CCN 010101
  • Walker Baptist Medical Center Hospital, Jasper, AL, CCN 010089

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting48
Leg revascularization (restoring blood flow)46

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20180612001685 AL Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8022071497 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36112374ILMDDiagnostic Ultrasound Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tombigbee Healthcare Authority Family Medicine CurrentSince Aug 23, 2021 Accepting new patients
Tombigbee Healthcare Authority CurrentSince Aug 23, 2021 Accepting new patients
Baptist Health Centers LLC CurrentSince Aug 1, 2019 Accepting new patients
Baptist Health Centers, LLC CurrentSince Aug 1, 2019 Accepting new patients
Baptist Health Centers, LLC Current Accepting new patients
Tombigbee Healthcare Authority Current Accepting new patients
Cardiovascular Associates of the Southeast, L.L.C Cardiovascular Disease Past Accepting new patients
Rockford Cardiology Associates, LTD Cardiovascular Disease Past Accepting new patients

Locations

3980 Colonnade Pkwy
Birmingham, AL 35243
Phone (205) 795-5390

833 Princeton Ave SW
Birmingham, AL 35211
Phone (205) 783-3098

1130 22nd St S
Ste 1000
Birmingham, AL 35205
Phone (205) 518-8849

105 US Highway 80 E
Ste 230
Demopolis, AL 36732
Phone (334) 287-2840

105 US Highway 80 E
Demopolis, AL 36732
Phone (334) 287-2669

Interoperability endpoints

  • Direct secure messaging: jskowronski64651@baptisthealthaldirect.org

Specialties & licenses 6

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 36112374 IL
Interventional Cardiology Physician 207RI0011X 36112374 IL Primary
Nuclear Cardiology Physician 207UN0901X 36112374 IL
Body Imaging Physician 2085B0100X 36112374 IL
Vascular & Interventional Radiology Physician 2085R0204X 36112374 IL
Diagnostic Ultrasound Physician 2085U0001X 36112374 IL

Addresses

NPPES NPI Registry

Primary practice location

444 Roxbury Road
Rockford, IL 61107-5059

Mailing address

PO Box 6003
Rockford, IL 61126-6003
Phone (815) 398-3000

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
036112374 1MedicaidIL
CB0709/P0015992OtherGARR MEDICARE GROUP #/PIN
101 15504OtherILB/C B/S OF ILLINOIS

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 22, 2015.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421884800000",
    "number": "1790710283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6003",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611266003",
            "telephone_number": "815-398-3000",
            "fax_number": "815-391-5096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 ROXBURY ROAD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075059",
            "telephone_number": "815-398-3000",
            "fax_number": "815-398-3041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKOWRONSKI",
        "first_name": "JAN",
        "middle_name": "PAWEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2015-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "36112374",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "36112374",
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "IL",
            "license": "36112374",
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "IL",
            "license": "36112374",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IL",
            "license": "36112374",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "IL",
            "license": "36112374",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036112374 1",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP #/PIN",
            "identifier": "CB0709/P0015992",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "B/C B/S OF ILLINOIS",
            "identifier": "101 15504",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.