NPIMap

Individual provider Active NPI

Kacey Cotoli Gibson, D.O.

  • Family Medicine Physician
  • Pensacola, FL
National Provider Identifier
1366640310
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS 10499 Issued in FL
Practice address
790 Veterans Way
Pensacola, FL 32507-1000
Phone
(850) 912-2000
NPI assigned
Jul 10, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS 10499 FL Primary

Addresses

Primary practice location

790 Veterans Way
Pensacola, FL 32507-1000

Mailing address

4511 N Davis Hwy
# 1-C
Pensacola, FL 32503-2720
Phone (850) 477-3252

Other practice location 1

3250 Zemke Ave
MacDill AFB, FL 33621
Phone (813) 828-2273

Other practice location 2

1200 Gulf Breeze Pkwy Ste B
Gulf Breeze, FL 32561-4855
Phone (850) 916-3680

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20110613000691 FL Practitioner - Family Practice 4082891395 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Nova Southeastern College of Osteo Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gary Gotthelf, M.D., P.a.Group PAC ID 2466352224, 6 clinicians

Practice addresses (Care Compare)

2120 E Johnson Ave
Suite 100
Pensacola, FL 32514-6091
Phone (850) 477-3252

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS 10499FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gary Gotthelf MD and Associates Inc CurrentSince May 24, 2021 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

4511 N Davis Hwy
#1C
Pensacola, FL 32503
Phone (850) 477-3252

2120 E Johnson Ave
Ste 100
Pensacola, FL 32514
Phone (850) 477-3252

2120 E Johnson Ave
Pensacola, FL 32514
Phone (850) 494-4885

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1366640310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4511 N DAVIS HWY",
            "address_2": "# 1-C",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032720",
            "telephone_number": "850-477-3252",
            "fax_number": "850-477-2659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 VETERANS WAY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325071000",
            "telephone_number": "850-912-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3250 Zemke Ave",
            "address_purpose": "LOCATION",
            "city": "MacDill AFB",
            "state": "FL",
            "postal_code": "33621",
            "country_code": "US",
            "telephone_number": "813-828-2273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 Gulf Breeze Pkwy Ste B",
            "address_purpose": "LOCATION",
            "city": "Gulf Breeze",
            "state": "FL",
            "postal_code": "325614855",
            "country_code": "US",
            "telephone_number": "850-916-3680",
            "fax_number": "850-916-3689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "KACEY",
        "middle_name": "COTOLI",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-10",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS 10499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.