Individual provider Active NPI

John M Gazak, MD

  • Pediatric Urology Physician
  • Charlotte, NC
National Provider Identifier
1811000425
Registry record updated Mar 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
License
25023 Issued in NC
Practice address
1420 E 7TH St
Charlotte, NC 28204-2408
Phone
(704) 375-0100
Fax
(704) 887-6450
NPI assigned
Aug 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 25023 NC
Pediatric Urology Physician 2088P0231X 25023 NC Primary

Addresses

Primary practice location

1420 E 7TH St
Charlotte, NC 28204-2408

Mailing address

1420 E 7TH St
Charlotte, NC 28204-2408
Phone (704) 375-0100

Other identifiers 1

IdentifierTypeStateIssuer
8934991MedicaidNC

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
25023NCMDAmbulatory Care Pharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Stone Institute of the Carolinas LLC Urology PastSince Apr 1, 1990 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456876800000",
    "number": "1811000425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 E 7TH ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042408",
            "telephone_number": "704-375-0100",
            "fax_number": "704-887-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 E 7TH ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042408",
            "telephone_number": "704-375-0100",
            "fax_number": "704-887-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAZAK",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2016-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NC",
            "license": "25023",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "NC",
            "license": "25023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8934991",
            "state": "NC"
        }
    ],
    "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 2, 2016; 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.