NPIMap

Individual provider Active NPI

Jacob Kozacki, DO

  • Family Medicine Physician
  • Florence, SC
National Provider Identifier
1396205878
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
82166 Issued in SC
Practice address
1594 Freedom Blvd Ste 202
Florence, SC 29505-6046
Phone
(843) 664-9696
NPI assigned
Mar 21, 2019
Last updated
Jun 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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 82166 SC Primary

Addresses

Primary practice location

1594 Freedom Blvd Ste 202
Florence, SC 29505-6046

Mailing address

1594 Freedom Blvd Ste 202
Florence, SC 29505-6046
Phone (843) 664-9696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20220822003404 SC Practitioner - Family Practice 6204166069 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Virginia Commonwealth University, School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

1594 Freedom Blvd
Florence, SC 29505-6046
Phone (843) 792-1414

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
82166SCMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Jul 10, 2023 Accepting new patients
St Francis Physician Services Inc CurrentSince Jul 31, 2022 Accepting new patients
Musc Community Physicians Current Accepting new patients
St Francis Physician Services Inc Family Medicine CurrentSince Jul 31, 2022 Accepting new patients
Musc Community Physicians Family Medicine CurrentSince Jul 10, 2023 Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

1594 Freedom Blvd
Ste 202
Florence, SC 29505
Phone (843) 644-9696

1200 Brookfield Blvd
Ste 400B
Greenville, SC 29607
Phone (864) 605-3721

Interoperability endpoints

  • Direct secure messaging: jkozacki430315@direct.musc.edu

Organizations & group practices 6

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 9

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": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1396205878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1594 FREEDOM BLVD STE 202",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295056046",
            "telephone_number": "843-664-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1594 FREEDOM BLVD STE 202",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295056046",
            "telephone_number": "843-664-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZACKI",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-21",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "82166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.