NPIMap

Organization Active NPI

Kopa LLC

  • Multi-Specialty Clinic/Center
  • Orlando, FL
National Provider Identifier
1417021114
Registry record updated Dec 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
KOPA LLC
Practice address
5900 Lake Ellenor Dr Ste 700
Orlando, FL 32809-4643
Phone
(407) 352-2542
Fax
(844) 556-8650
NPI assigned
Nov 17, 2006
Reactivated
Dec 22, 2023
Last updated
Dec 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2023

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

Authorized official

Name
Kimberly L Biegasiewicz
Title
President
Phone
(407) 216-0101

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary
Hospitalist Physician 208M00000X NU

Addresses

Primary practice location

5900 Lake Ellenor Dr Ste 700
Orlando, FL 32809-4643

Mailing address

5900 Lake Ellenor Dr Ste 700
Orlando, FL 32809-4643
Phone (407) 352-2542

Other identifiers 3

IdentifierTypeStateIssuer
94707OtherFLBLUE CROSS BLUE SHEILD
107434200MedicaidFL
HCC10648OtherFLAHCA

Other names 1

  • KOPA PA, Coast To Coast Physicians Alliance, Sand Lake Hospitalists, Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050113001021 FL Part B Supplier - Clinic/Group Practice 5193774461 Receives reassigned benefits from 49 practitioners
Practice locations: Orlando, FL; Saint Cloud, FL; Kissimmee, FL; Ocoee, FL

National Provider Directory

National Provider Directory

Locations

5728 Major Blvd
Ste 528
Orlando, FL 32819

5900 Lk Ellenor Dr
Orlando, FL 32809
Phone (407) 352-6968

Practitioners & affiliated clinicians

Practitioners 61

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703203200000",
    "number": "1417021114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 LAKE ELLENOR DR STE 700",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328094643",
            "telephone_number": "407-352-2542",
            "fax_number": "844-556-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 LAKE ELLENOR DR STE 700",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328094643",
            "telephone_number": "407-352-2542",
            "fax_number": "844-556-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2023-12-22",
        "certification_date": "2023-10-02",
        "deactivation_date": "2023-12-15",
        "reactivation_date": "2023-12-22",
        "status": "A",
        "authorized_official_last_name": "BIEGASIEWICZ",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-216-0101"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "94707",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107434200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA",
            "identifier": "HCC10648",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KOPA PA, Coast To Coast Physicians Alliance, Sand Lake Hospitalists,",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "KOPA PA, Coast To Coast Physicians Alliance, Sand Lake Hospitalists,",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.