Jaroslaw Mark Ambroziak (NPI# 1477506459, PAC ID# 6406971985) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1477506459 |
| PAC ID by PECOS | 6406971985 |
| Professional Enrollment ID | I20101012000331 |
| Full Name | Jaroslaw Mark Ambroziak |
| Organization Legal Name | PROVIDENCE FAMILY PRACTICE LLC |
| Address |
115 Blarney Dr Suite 212 Columbia SC 29223-6291 |
| Phone Number | 8032545171 |
| Gender | M |
| Medical School | UNIVERSITY OF MINNESOTA MEDICAL SCHOOL |
| Graduation Year | 1997 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 4284658865 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 420018 | PALMETTO HEALTH RICHLAND |
| 420026 | PROVIDENCE HEALTH |
| 420086 | PALMETTO HEALTH BAPTIST |
| 420073 | LEXINGTON MEDICAL CENTER |
| 420106 | PALMETTO HEALTH BAPTIST PARKRIDGE |
| Address | Phone | Organization |
|---|---|---|
| 115 Blarney Dr, Suite 212, Columbia, SC 29223-6291 | 8032545171 | PROVIDENCE FAMILY PRACTICE LLC |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| ACI_EC_TRANS_PHCDRR_1 | Immunization Registry Reporting | % | |
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % | |
| MIPS_EC_119_overall | Diabetes: Medical Attention for Nephropathy | 80% |
| Organization Legal Name | PROVIDENCE FAMILY PRACTICE LLC |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Frampton W Henderson Jr. | Family Medicine | Providence Family Practice LLC | 115 Blarney Dr, Suite 212, Columbia, SC 29223-6291 |
| Theodore W Law Iv | Family Medicine | Providence Family Practice LLC | 115 Blarney Dr, Suite 212, Columbia, SC 29223-6291 |
| James Alan Henderson | Family Medicine | Providence Family Practice LLC | 115 Blarney Dr, Suite 212, Columbia, SC 29223-6291 |
| Street Address |
115 BLARNEY DR SUITE 212 |
| City | COLUMBIA |
| State | SC |
| Zip | 29223-6291 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Theodore Cobert Belsches | Internal Medicine | Palmetto Health-university of South Carolina Medical Group | 115 Blarney Dr, Suite 108, Columbia, SC 29223-6291 |
| Anna K Willard | Nurse Practitioner | Palmetto Health-university of South Carolina Medical Group | 115 Blarney Dr, Suite 108, Columbia, SC 29223-6291 |
| Frampton W Henderson Jr. | Family Medicine | Providence Family Practice LLC | 115 Blarney Dr, Suite 212, Columbia, SC 29223-6291 |
| Theodore W Law Iv | Family Medicine | Providence Family Practice LLC | 115 Blarney Dr, Suite 212, Columbia, SC 29223-6291 |
| Stephen M Tuel | Physical Medicine and Rehabilitation | 115 Blarney Dr, Columbia, SC 29223-6291 | |
| Marisa V Gentry | Nurse Practitioner | Palmetto Health-university of South Carolina Medical Group | 115 Blarney Dr, Suite 108, Columbia, SC 29223-6291 |
| Katherine Marie Coleman | Nurse Practitioner | Palmetto Health-university of South Carolina Medical Group | 115 Blarney Dr, Suite 209, Columbia, SC 29223-6291 |
| James Alan Henderson | Family Medicine | Providence Family Practice LLC | 115 Blarney Dr, Suite 212, Columbia, SC 29223-6291 |
| Melissa E Boylan | Family Medicine | Palmetto Health-university of South Carolina Medical Group | 115 Blarney Dr, Suite 209, Columbia, SC 29223-6291 |
| Rodney Fitzgibbon Ii | Family Medicine | Palmetto Health-university of South Carolina Medical Group | 115 Blarney Dr, Suite 209, Columbia, SC 29223-6291 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Barry K Feinstein | Allergy/immunology | Advanced Allergy and Asthma of Virginia | 31143 Truamn St, Columbia, DE 29223 |
| Margaret H Sigman | Allergy/immunology | Advanced Allergy and Asthma of Virginia | 31143 Truamn St, Columbia, DE 29223 |
| Carmen Jimenez | Clinical Social Worker | 300 Berkshire Dr, Suite F, Columbia, SC 29223-1859 | |
| Philip J Michels | Psychologist, Clinical | 9890 Windsor Lake Blvd, Columbia, SC 29223-2028 | |
| Carl Dewayne Brinkman | Physician Assistant | United Physician Group LLC | 7201 Brookfield Rd, Columbia, SC 29223-2215 |
| Carl Issac Mitchell | Internal Medicine | 7201 Brookfield Rd, Columbia, SC 29223-2215 | |
| Madelyn Garcia | Physician Assistant | Lagniappe Medical Clinics LLC | 74 Polo Rd, Columbia, SC 29223-2806 |
| Robert W Christensen | Physician Assistant | Lexington County Health Services District Inc | 76 Polo Rd, Columbia, SC 29223-2806 |
| Karen N Moon | Podiatry | Lagniappe Medical Clinics LLC | 74 Polo Rd, Columbia, SC 29223-2806 |
| Wachovia Chanta Banks | Obstetrics/gynecology | Lagniappe Medical Clinics LLC | 74 Polo Rd, Columbia, SC 29223-2806 |
| Find all physicians in zip 29223 | |||
| City | COLUMBIA |
| Zip Code | 29223 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | COLUMBIA + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Jaroslaw Mark Ambroziak.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.