Matthew J Kocisko, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

ME078891 Issued in FL

Practice address

303 N Clyde Morris Blvd
Daytona Beach, FL 32114-2709

Phone

(386) 254-2285

Fax

(386) 425-1304

NPI assigned

Nov 17, 2006

Last updated

Feb 27, 2016By 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 2

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Halifax Healthcare Systems Inc

  dba HHCSI Halifax Family Health Center

  • Family Medicine Physician
  • Daytona Beach, FL
  • NPI 1245283530

  Emergency Medicine

  Medicare reassignment NPD
• Halifax Healthcare Systems Inc

  dba HHCSI Halifax Open Heart

  • Cardiovascular Disease Physician
  • Daytona Beach, FL
  • NPI 1366452591
  NPD (past)

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456531200000",
    "number": "1477627107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142709",
            "telephone_number": "386-254-2285",
            "fax_number": "386-425-1304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142709",
            "telephone_number": "386-254-2285",
            "fax_number": "386-425-1304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCISKO",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2016-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME078891",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0078891",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "ME78891",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "259535400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ilse Kluever, PT
• Crystal Alisa Knight, LCSW
• Justin William Knighton
• Wayne Alan Knocke, RPH
• Jennifer Koblik
• Lucas Todd Kockler, LMHC
• Joyson Kodiyan, MD
• Kimberly Kay Koevenig, RD, LD/N, CDE
• Michael D Kohen, M.D.
• Frank R Kohler Jr., D.O.

• Emergency Medicine Physician in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Emergency Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.