Justin R Kolasa, D.M.D., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

9346 Issued in KY

Practice address

400 S 4TH St
Danville, KY 40422-2094

Phone

(859) 236-1130

Fax

(859) 239-9384

NPI assigned

May 7, 2013

Last updated

Jan 18, 2023By 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 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral Surgery

Education

University of Kentucky College of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beto and BogardusGroup PAC ID 5799757514, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Beto & Bogardus

  • Oral and Maxillofacial Surgery (Dentist)
  • Danville, KY
  • NPI 1730259292
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1598100372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S 4TH ST",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404222094",
            "telephone_number": "859-236-1130",
            "fax_number": "859-239-0050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S 4TH ST",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404222094",
            "telephone_number": "859-236-1130",
            "fax_number": "859-239-9384"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "399 W Maple Leaf Rd",
            "address_purpose": "LOCATION",
            "city": "Maysville",
            "state": "KY",
            "postal_code": "410569176",
            "country_code": "US",
            "telephone_number": "606-564-9495",
            "fax_number": "606-564-9495",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Rose St",
            "address_2": "Oral and Maxillofacial Surgery",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405360292",
            "country_code": "US",
            "telephone_number": "859-749-5824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLASA",
        "first_name": "JUSTIN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-07",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "9346",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100290020",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vera S King, ARNP
• Kiosk Medicine of Kentucky LLC
• Sonya Kirkpatrick
• Robert Paul Knetsche, M.D.
• Alfred Harold Kokwaro, MD
• Katrina Ann Kolasa, M.D.
• Frank A Koroluk, PA
• Panayota Kotsali, MD
• Barry Michael Kowalik, OD
• Kroger Limited Partnership I (Kroger Pharmacy)

• Oral and Maxillofacial Surgery (Dentist) in Danville, KY
• Providers in Danville, KY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.