Robert O Kessack III, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9105462 Issued in FL

Practice address

216 Frederick St
Pierson, FL 32180-3024

Phone

(386) 749-9449

Fax

(386) 749-2280

NPI assigned

May 18, 2006

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Northeast Florida Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pierson, FL
  • NPI 1992792311
  Medicare reassignment NPD
• Northeast Florida Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Deltona, FL
  • NPI 1427605534
  NPD
• Marysville Emergency Physicians Inc.

  • Emergency Medicine Physician
  • Marysville, OH
  • NPI 1649271594
  NPD (past)
• Middletown Emergency Physicians, Inc.

  • Emergency Medicine Physician
  • Franklin, OH
  • NPI 1932108784
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429142400000",
    "number": "1497708952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 FREDERICK ST",
            "city": "PIERSON",
            "state": "FL",
            "postal_code": "321803024",
            "telephone_number": "386-749-9449",
            "fax_number": "386-749-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 FREDERICK ST",
            "city": "PIERSON",
            "state": "FL",
            "postal_code": "321803024",
            "telephone_number": "386-749-9449",
            "fax_number": "386-749-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESSACK",
        "first_name": "ROBERT",
        "middle_name": "O",
        "name_suffix": "III",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2015-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE, FLORIDA",
            "identifier": "PA9105462",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002724600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackie Elaine Beatty, M.A. CCC-SLP
• Maryann Mehlfelder Danker, ARNP
• Peter Desouza, MD
• Paige Fisher
• Ranie Kemp, NP
• Lake George Dental
• Love Life Psychiatry
• Jorge Luis Martinez Bruna
• Vianey Martinez, APRN
• Med-Trans Corporation

• Physician Assistant in Pierson, FL
• Providers in Pierson, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; 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.