NPIMap

Individual provider Active NPI

Edward F Jastrzemski, M.D.

  • Internal Medicine Physician
  • Kent, OH
National Provider Identifier
1962577726
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35055512 Issued in OH
Practice address
408 Devon PL
Suite B
Kent, OH 44240-6479
Phone
(330) 673-6235
Fax
(330) 678-8811
NPI assigned
Nov 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35055512 OH Primary

Addresses

Primary practice location

408 Devon PL
Suite B
Kent, OH 44240-6479

Mailing address

408 Devon PL
Suite B
Kent, OH 44240-6479
Phone (330) 673-6235

Other identifiers 1

IdentifierTypeStateIssuer
0859227MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address edwardjastrzemski@uhps.allscriptsdirect.net
Direct Messaging Address edwardjastrzemski@uhps.allscripsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20100226000425 OH Practitioner - Internal Medicine 8921143140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Toledo Medical College, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Primary Care Practices IncGroup PAC ID 3072417534, 1,071 clinicians

Practice addresses (Care Compare)

11100 Euclid Ave
Cleveland, OH 44106-1716

158 W Main Rd
Conneaut, OH 44030-2039

Hospital & facility affiliations

  • University Hospital Home Care Services, Inc Home health agency, Warrensville HTS, OH, CCN 367424
  • Patriot Homecare, Inc Home health agency, Girard, OH, CCN 368406
  • University Hospitals Portage Medical Center Hospital, Ravenna, OH, CCN 360078
  • Uh Cleveland Medical Center Hospital, Cleveland, OH, CCN 360137

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35055512OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Primary Care Practices Inc CurrentSince Jan 1, 2016 Accepting new patients
University Primary Care Practices Inc Current Accepting new patients
University Primary Care Practices Inc Internal Medicine CurrentSince Jan 1, 2016 Accepting new patients
University Primary Care Practices Past Accepting new patients

Locations

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

Interoperability endpoints

  • Direct secure messaging: ejastrzemski21135@ehrdirect.uhhospitals.org

Organizations & group practices 4

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 7

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": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610668800000",
    "number": "1962577726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 DEVON PL",
            "address_2": "SUITE B",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442406479",
            "telephone_number": "330-673-6235",
            "fax_number": "330-678-8811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 DEVON PL",
            "address_2": "SUITE B",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442406479",
            "telephone_number": "330-673-6235",
            "fax_number": "330-678-8811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JASTRZEMSKI",
        "first_name": "EDWARD",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35055512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0859227",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "edwardjastrzemski@uhps.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "401 Devon Pl Ste 215",
            "city": "Kent",
            "state": "OH",
            "country_code": "US",
            "postal_code": "442406483",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "edwardjastrzemski@uhps.allscripsdirect.net",
            "affiliation": "N",
            "address_1": "401 Devon Pl Ste 215",
            "city": "Kent",
            "state": "OH",
            "country_code": "US",
            "postal_code": "442406483",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kent, OH

Sources for this page

Verify at the official NPI Registry.