Organization Active NPI

Jaroslaw K Paszkowiak MD PC

  • Family Medicine Physician
  • Lawton, OK
National Provider Identifier
1790887263
Registry record updated Feb 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JAROSLAW K PASZKOWIAK MD PC
Practice address
4411 W Gore Blvd
Ste B1
Lawton, OK 73505-5977
Phone
(580) 248-8000
NPI assigned
Sep 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2014

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

Authorized official

Name
Jaroslaw Paszkowiak, MDNPI 1205899333
Title
Owner
Phone
(580) 248-8000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4411 W Gore Blvd
Ste B1
Lawton, OK 73505-5977

Mailing address

4411 W Gore Blvd
Ste B1
Lawton, OK 73505-5977
Phone (580) 248-8000

Other identifiers 3

IdentifierTypeStateIssuer
200082480BMedicaidOK
200095800AMedicaidOK
P00435232OtherOKMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061012000545 OK Part B Supplier - Clinic/Group Practice 1951307040 Receives reassigned benefits from 2 practitioners
Practice locations: Lawton, OK

National Provider Directory

National Provider Directory

Locations

4411 W Gore Blvd
Ste B1
Lawton, OK 73505
Phone (580) 248-8000

4411 W Gore Blvd
#B1B2
Lawton, OK 73505

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HIHECD

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392681600000",
    "number": "1790887263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 W GORE BLVD",
            "address_2": "STE B1",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735055977",
            "telephone_number": "580-248-8000",
            "fax_number": "580-248-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 W GORE BLVD",
            "address_2": "STE B1",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735055977",
            "telephone_number": "580-248-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAROSLAW K PASZKOWIAK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-03",
        "last_updated": "2014-02-18",
        "status": "A",
        "authorized_official_last_name": "PASZKOWIAK",
        "authorized_official_first_name": "JAROSLAW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-248-8000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200082480B",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200095800A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00435232",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.