NPIMap

Individual provider Active NPI

Nina Elisabeth Kozar

  • Medical Physician Assistant
  • Leesport, PA
National Provider Identifier
1154169035
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
OA006929 Issued in PA
Practice address
5 S Centre Ave Ste A3
Leesport, PA 19533-8661
Phone
(610) 926-8352
NPI assigned
Jul 16, 2024
Last updated
Oct 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X OA006929 PA Primary

Addresses

Primary practice location

5 S Centre Ave Ste A3
Leesport, PA 19533-8661

Mailing address

5 S Centre Ave Ste A3
Leesport, PA 19533-8661
Phone (610) 926-8352

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20240729002469 PA Practitioner - Physician Assistant 6305382169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1120 Cocoa Ave
Hershey, PA 17033-1712
Phone (717) 533-4141

5 S Centre Ave
Suite A3 Pshmg Schuylkill Valley
Leesport, PA 19533-8661
Phone (610) 926-5707

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Penn State Health Medical Group, LLC CurrentSince Aug 1, 2024 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Aug 1, 2024 Accepting new patients
Penn State Health Medical Group, LLC Past Accepting new patients

Locations

1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141

5 S Centre Ave
Ste A3
Leesport, PA 19533
Phone (610) 926-5707

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1154169035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 S CENTRE AVE STE A3",
            "city": "LEESPORT",
            "state": "PA",
            "postal_code": "195338661",
            "telephone_number": "610-926-8352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 S CENTRE AVE STE A3",
            "city": "LEESPORT",
            "state": "PA",
            "postal_code": "195338661",
            "telephone_number": "610-926-8352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZAR",
        "first_name": "NINA",
        "middle_name": "ELISABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "OA006929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesport, PA

Sources for this page

Verify at the official NPI Registry.