Active NPI
Russell Scott Kaczmar, PT, DPT
- Physical Therapist
- Escondido, CA
National Provider Identifier
1659804938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 292758
- Practice address
- 215 S Hickory St
Ste. 112
Escondido, CA 92025-4359 - Phone
- (760) 737-8460
- Fax
- (760) 739-5669
- NPI assigned
- Apr 4, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 292758 | CA | Primary |
Addresses
Primary practice location
215 S Hickory St
Ste. 112
Escondido, CA 92025-4359
Mailing address
2690 Kremeyer Cir
Apt. 3
Carlsbad, CA 92008-1648
Phone (530) 318-2967
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 292758 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491264000000",
"number": "1659804938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2690 KREMEYER CIR",
"address_2": "APT. 3",
"city": "CARLSBAD",
"state": "CA",
"postal_code": "920081648",
"telephone_number": "530-318-2967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 S HICKORY ST",
"address_2": "STE. 112",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920254359",
"telephone_number": "760-737-8460",
"fax_number": "760-739-5669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KACZMAR",
"first_name": "RUSSELL",
"middle_name": "SCOTT",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-04",
"last_updated": "2017-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "292758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Escondido, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.