Jeren Robert Kowalewski, PA-C

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

9112658 Issued in FL

Practice address

1340 Citizens Blvd
Leesburg, FL 34748-3924

Phone

(352) 435-7695

NPI assigned

Jan 21, 2020

Last updated

Jan 21, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Merit-based Incentive Payment System (MIPS)

Final score

95.29 of 100Reported as group

Quality

90.57

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Johnny Gurgen DO PA

  • Dermatology Physician
  • Lady Lake, FL
  • NPI 1770856833
  Medicare reassignment

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

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579564800000",
    "number": "1174153969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 ROLLING ACRES RD UNIT 205",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321595029",
            "telephone_number": "352-633-7930",
            "fax_number": "352-633-7924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 CITIZENS BLVD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347483924",
            "telephone_number": "352-435-7695"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 Rolling Acres Rd Unit 205",
            "address_purpose": "LOCATION",
            "city": "Lady Lake",
            "state": "FL",
            "postal_code": "321595029",
            "country_code": "US",
            "telephone_number": "352-633-7930 x35263",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOWALEWSKI",
        "first_name": "JEREN",
        "middle_name": "ROBERT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "9112658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Howard Knueven, R.PH.
• Jennifer Koeller, PA-C
• Taneshia Lynea Koon
• Ashley Koppel
• Kathryn Nikolaos Koulias, P.T.
• Madelynne M Kugler, ARNP
• Rolf Kuhns, P.T.
• Karen G Kuperberg, A.R.N.P.
• Karlton Jiang Teim Kwan, D.C.
• Jennifer A Kyle, PTA

• Dermatology Physician in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.