Active NPI
Stanley J. Kotara, PA
- Physician Assistant
- Lubbock, TX
National Provider Identifier
1699738302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA03194
- Practice address
- 4110 22ND PL
Lubbock, TX 79410-1122 - Phone
- (806) 792-4329
- Fax
- (806) 792-9466
- NPI assigned
- Apr 11, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA03194 | TX | Primary |
Addresses
Primary practice location
4110 22ND PL
Lubbock, TX 79410-1122
Mailing address
4110 22ND PL
Lubbock, TX 79410-1122
Phone (806) 792-4329
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8Y8601 | Other | TX | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CSK Medical Partners | Current | Accepting new patients | |
| Mary Black Physician Services LLC | Physician Assistant | Past | Accepting new patients |
Locations
4110 22nd Pl
Lubbock, TX 79410
Phone (806) 792-4329
Organizations & group practices 3
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.
-
dba Lubbock Sports Rehab
- Physical Therapy Clinic/Center
- Lubbock, TX
- NPI 1467576793
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321920000000",
"number": "1699738302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4110 22ND PL",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794101122",
"telephone_number": "806-792-4329",
"fax_number": "806-792-9466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4110 22ND PL",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794101122",
"telephone_number": "806-792-4329",
"fax_number": "806-792-9466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOTARA",
"first_name": "STANLEY",
"middle_name": "J.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-11",
"last_updated": "2011-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA03194",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "8Y8601",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; 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.