Individual provider Active NPI

Kyle S Fallgatter, MD

  • Ophthalmology Physician
  • Jacksonville, FL
National Provider Identifier
1588160188
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
ME168086 Issued in FL
Practice address
2639 Oak St
Jacksonville, FL 32204-4505
Phone
(904) 387-5600
Fax
(904) 388-0114
NPI assigned
Apr 3, 2018
Last updated
Aug 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 101374 GA
Ophthalmology Physician 207W00000X ME168086 FL Primary
Retina Specialist (Ophthalmology) Physician 207WX0107X ME168086 FL
Retina Specialist (Ophthalmology) Physician 207WX0107X 101374 GA

Addresses

Primary practice location

2639 Oak St
Jacksonville, FL 32204-4505

Mailing address

2639 Oak St
Jacksonville, FL 32204-4505
Phone (904) 387-5600

Other practice location 1

50 Leanni Way Unit E5
Palm Coast, FL 32137-4757
Phone (386) 447-1847

Other practice location 2

3120 Glynn Ave
Brunswick, GA 31520-4848
Phone (912) 262-9092

Other practice location 3

2416 Lynndale Rd Ste 201
Fernandina Beach, FL 32034-5230
Phone (904) 997-9202

Other practice location 4

8786 Perimeter Park Blvd
Jacksonville, FL 32216-6347
Phone (904) 997-9202

Other practice location 5

304 Riverside Dr
Waycross, GA 31501-4549
Phone (912) 283-1400

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kfallgatter@floridaretinainstitute.intellechartdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240621002148 FL Practitioner - Ophthalmology 2668718131 Reassigns benefits to 1 organization
I20241009003121 GA Practitioner - Ophthalmology 2668718131 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Florida College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Retina Vitreous ConsultantsGroup PAC ID 4082610019, 43 clinicians

Practice addresses (Care Compare)

2639 Oak St
Jacksonville, FL 32204-4505
Phone (904) 387-5600

3120 Glynn Ave
Brunswick, GA 31520-4848
Phone (912) 262-9092

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
99
Promoting interoperability
99
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
80.94 of 100Reported as group
Quality
61.89
Promoting interoperability
100
Improvement activities
40
Cost
74.58

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Retina Institute James a Staman MD LLC Ophthalmology CurrentSince Jul 1, 2024 Accepting new patients
Retina Vitreous Consultants Ophthalmology CurrentSince Jul 1, 2024 Accepting new patients

Locations

950 Glades Rd
Ste 1C
Boca Raton, FL 33431
Phone (305) 294-5504

2416 Lynndale Rd
Ste 201
Fernandina Beach, FL 32034
Phone 9042615741134

6333 N Federal Hwy
Ste 300
Ft Lauderdale, FL 33308
Phone (954) 776-6880

2639 Oak St
Jacksonville, FL 32204
Phone (904) 387-5600

8786 Perimeter Park Blvd
Jacksonville, FL 32216
Phone (904) 997-9202

50 Leanni Way
Unit E5
Palm Coast, FL 32137
Phone (386) 447-1847

2055 Little Rd
Trinity, FL 34655
Phone (727) 376-7820

1370 E Venice Ave
Ste 201
Venice, FL 34285
Phone (941) 480-0500

3120 Glynn Ave
Brunswick, GA 31520
Phone (912) 262-9092

304 Riverside Dr
Waycross, GA 31501
Phone (912) 283-1400

Interoperability endpoints

  • Direct secure messaging: kfallgatter@floridaretinainstitute.intellechartdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1588160188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2639 OAK ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044505",
            "telephone_number": "904-387-5600",
            "fax_number": "904-996-1446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2639 OAK ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044505",
            "telephone_number": "904-387-5600",
            "fax_number": "904-388-0114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 Leanni Way Unit E5",
            "address_purpose": "LOCATION",
            "city": "Palm Coast",
            "state": "FL",
            "postal_code": "321374757",
            "country_code": "US",
            "telephone_number": "386-447-1847",
            "fax_number": "386-447-1848",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3120 Glynn Ave",
            "address_purpose": "LOCATION",
            "city": "Brunswick",
            "state": "GA",
            "postal_code": "315204848",
            "country_code": "US",
            "telephone_number": "912-262-9092",
            "fax_number": "912-466-0639",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2416 Lynndale Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Fernandina Beach",
            "state": "FL",
            "postal_code": "320345230",
            "country_code": "US",
            "telephone_number": "904-997-9202",
            "fax_number": "904-997-9205",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8786 Perimeter Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322166347",
            "country_code": "US",
            "telephone_number": "904-997-9202",
            "fax_number": "904-997-9205",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "304 Riverside Dr",
            "address_purpose": "LOCATION",
            "city": "Waycross",
            "state": "GA",
            "postal_code": "315014549",
            "country_code": "US",
            "telephone_number": "912-283-1400",
            "fax_number": "912-283-0019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FALLGATTER",
        "first_name": "KYLE",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "GA",
            "license": "101374",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME168086",
            "primary": true
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "FL",
            "license": "ME168086",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "GA",
            "license": "101374",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kfallgatter@floridaretinainstitute.intellechartdirect.net",
            "affiliation": "N",
            "address_1": "8786 Perimeter Park Blvd",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322166347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.