Individual provider Active NPI

Kara Jean Kobylka Russell, P.A.

  • Surgical Physician Assistant
  • Orlando, FL
National Provider Identifier
1164732673
Registry record updated Nov 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA9105628 Issued in FL
Practice address
1222 S Orange Ave
Orlando, FL 32806-1215
Phone
(407) 649-6878
Fax
(321) 843-2172
NPI assigned
Oct 18, 2010
Last updated
Nov 15, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9105628 FL
Surgical Physician Assistant 363AS0400X PA9105628 FL Primary

Addresses

Primary practice location

1222 S Orange Ave
Orlando, FL 32806-1215

Mailing address

1222 S Orange Ave
Orlando, FL 32806-1215
Phone (407) 649-6878

Other identifiers 2

IdentifierTypeStateIssuer
004172500MedicaidFL
PA9105628OtherFLMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110406000668 FL Practitioner - Physician Assistant 7214111863 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

32 W Gore St
Orlando, FL 32806-1134

60 Columbia St
Orlando, FL 32806-1115
Phone (321) 843-5851

62 Columbia St
Orlando, FL 32806-1115
Phone (321) 843-5851

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9105628FLMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc CurrentSince Oct 1, 2011 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Oct 1, 2011 Accepting new patients
Orlando Orthopaedic Center MD PA Past Accepting new patients

Locations

1222 S Orange Ave
Orlando, FL 32806
Phone (407) 649-6907

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

1285 Orange Ave
Winter Park, FL 32789
Phone (407) 647-2287

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: kkobylkarussell31001@orlandohealth.medalliesdirect.net

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 2

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": "1287360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479168000000",
    "number": "1164732673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 S ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061215",
            "telephone_number": "407-649-6878",
            "fax_number": "321-843-2172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 S ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061215",
            "telephone_number": "407-649-6878",
            "fax_number": "321-843-2172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBYLKA RUSSELL",
        "first_name": "KARA",
        "middle_name": "JEAN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-18",
        "last_updated": "2016-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105628",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9105628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004172500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "PA9105628",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.