EDWARD D ZDOBYLAK M.D.
NPI 1558384545
Psychiatry & Neurology - Neurology in Elk City, OK
NPI Status: Active since July 25, 2006
Contact Information
1901 W 3RD
SUITEA
ELK CITY, OK
ZIP 73644
Phone: (580) 225-2513
Fax: (580) 303-5863
- Individual
- Male
- Years of Experience 29
- Psychiatry & Neurology
- Neurology
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About EDWARD ZDOBYLAK
This page provides the complete NPI Profile along with additional information for Edward Zdobylak, a provider established in Elk City, Oklahoma with a medical specialization in Psychiatry & Neurology, focusing in neurology and more than 29 years of experience. He graduated from Indiana University School Of Medicine in 1998. The healthcare provider is registered in the NPI registry with number 1558384545 assigned on July 2006. The practitioner's primary taxonomy code is 2084N0400X with license number 01051068A (IN). The provider is registered as an individual and his NPI record was last updated 3 years ago.
- NPI
- 1558384545
- Provider Name
- EDWARD D ZDOBYLAK M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 1901 W 3RD SUITEA ELK CITY, OK 73644
- Location Phone
- (580) 225-2513
- Location Fax
- (580) 303-5863
- Mailing Address
- PO BOX 2339 ELK CITY, OK 73648
- Mailing Phone
- (805) 225-2513
- Mailing Fax
- (580) 303-5863
- Medical School Name
- INDIANA UNIVERSITY SCHOOL OF MEDICINE
- Graduation Year
- 1998
- Is Sole Proprietor?
- No
- Enumeration Date
- 07-25-2006
- Last Update Date
- 05-03-2023
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Psychiatry & Neurology Neurology
- Taxonomy Code
- 2084N0400X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 01051068A
- License State
- IN
- Taxonomy Description
- A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Advantage Bronze PPO? 202 - PPO
- Blue Advantage Bronze PPO? 203 - PPO
- Blue Advantage Bronze PPO? Standard - PPO
- Blue Advantage Gold PPO? 309 - PPO
- Blue Advantage Gold PPO? 604 - PPO
- Blue Advantage Gold PPO? Standard - PPO
- Blue Advantage Silver PPO? 204 - PPO
- Blue Advantage Silver PPO? 501 - PPO
- Blue Advantage Silver PPO? Standard - PPO
- Blue Preferred Bronze PPO? Standard - PPO
- Blue Preferred Gold PPO? Standard - PPO
- Blue Preferred Security PPO? 200 - PPO
- Blue Preferred Silver PPO? Standard - PPO
- Harmony by Medica Bronze $0 Copay PCP Visits - PPO
- Harmony by Medica Bronze $0 Copay PCP Visits + Adult Eye Exam - PPO
- Harmony by Medica Bronze Premier - PPO
- Harmony by Medica Bronze Premier + Adult Eye Exam - PPO
- Harmony by Medica Expanded Bronze Standard - PPO
- Harmony by Medica Expanded Bronze Standard + Adult Eye Exam - PPO
- Harmony by Medica Gold $0 Copay PCP Visits - PPO
- Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam - PPO
- Harmony by Medica Gold Share - PPO
- Harmony by Medica Gold Share + Adult Eye Exam - PPO
- Harmony by Medica Gold Standard - PPO
- Harmony by Medica Gold Standard + Adult Eye Exam - PPO
- Harmony by Medica Silver $0 Copay PCP Visits - PPO
- Harmony by Medica Silver $0 Copay PCP Visits + Adult Eye Exam - PPO
- Harmony by Medica Silver Share - PPO
- Harmony by Medica Silver Share + Adult Eye Exam - PPO
- Harmony by Medica Silver Standard - PPO
- Harmony by Medica Silver Standard + Adult Eye Exam - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 000000939921 | OTHER (01) | IN | ANTHEM LEGACY # |
| 200377800 | MEDICAID (05) | IN |
Medicare Participation & PECOS Enrollment Status
Edward Zdobylak is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Edward Zdobylak is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 3072588961
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20230201000771
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Physician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $30.76 for a new patient copayment and $23.56 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 73644 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $123.06
- Minimum New Patient Price $53
- Maximum New Patient Price $162.61
- Average New Patient Copayment $30.76
- Minimum New Patient Copayment $13.25
- Maximum New Patient Copayment $40.65
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $94.27
- Minimum Established Patient Price $16.68
- Maximum Established Patient Price $132.4
- Average Established Patient Copayment $23.56
- Minimum Established Patient Copayment $4.17
- Maximum Established Patient Copayment $33.1
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Quality Reporting
The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Care Plan | 5% | 381 |
| Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan | ||
| Dementia: Functional Status Assessment | 2% | 45 |
| Percentage of patients with dementia for whom an assessment of functional status* was performed at least once in the last 12 months | ||
| Documentation of Current Medications in the Medical Record | 88% | 1628 |
| Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration | ||
| Falls: Screening for Future Fall Risk | 23% | 183 |
| Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period | ||
| Implementation of medication management practice improvements | Yes | N/A |
| Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews. | ||
| Leadership engagement in regular guidance and demonstrated commitment for implementing practice improvement changes | Yes | N/A |
| Ensure full engagement of clinical and administrative leadership in practice improvement that could include one or more of the following: Make responsibility for guidance of practice change a component of clinical and administrative leadership roles; Allocate time for clinical and administrative leadership for practice improvement efforts, including participation in regular team meetings; and/or Incorporate population health, quality and patient experience metrics in regular reviews of practice performance. | ||
| MEDICATION PRESCRIBED FOR ACUTE MIGRAINE ATTACK | 71% | 980 |
| Percentage of patients age 12 years and older with a diagnosis of migraine who were prescribed a guideline recommended medication for acute migraine attacks within the 12 month measurement period. | ||
| Parkinson's Disease: Psychiatric Symptoms Assessment for Patients with Parkinson's Disease | 16% | 25 |
| Percentage of all patients with a diagnosis of Parkinson's Disease [PD] who were assessed* for psychiatric symptoms** in the past 12 months | ||
| Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record | Yes | N/A |
| • Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following: • Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care); • Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/or Provision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management. | ||
| Screening for Psychiatric or Behavioral Health Disorders | 28% | 137 |
| Percent of all visits for patients with a diagnosis of epilepsy where the patient was screened for psychiatric or behavioral disorders. | ||
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Edward Zdobylak is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| GREAT PLAINS REGIONAL MEDICAL CENTER | 1801 WEST 3RD STREET ELK CITY, OK 73644 | (580) 225-2511 | Acute Care Hospitals |
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1558384545, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 75. The final step is to find the difference between that total and the next multiple of ten (80 - 75 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 75 is 80. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1558384545, enumerated as an "individual" on July 25, 2006.
The provider is located at 1901 W 3RD SUITEA ELK CITY, OK 73644 and the phone number is (580) 225-2513.
Psychiatry & Neurology with taxonomy code 2084N0400X and a focus in Neurology.
The provider might be accepting Accepts: Blue Cross and Blue Shield of Oklahoma, Medica,. Please consult your insurance carrier or call the provider to verify.
Edward Zdobylak is affiliated with: GREAT PLAINS REGIONAL MEDICAL CENTER.
