Carissa J Kostecki, MD

Primary specialty

Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X

License

ME85233 Issued in FL

Practice address

800 Prudential Dr
Jacksonville, FL 32207-8202

Phone

(904) 396-5682

Fax

(904) 346-0864

NPI assigned

Jul 17, 2006

Sex

Female

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 3

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Emergency Physicians Inc

  • Emergency Medicine Physician
  • Jacksonville, FL
  • NPI 1285686675
  Medicare reassignment NPD
• Emergency Physicians Inc

  • Emergency Medicine Physician
  • Brunswick, GA
  • NPI 1477001972
  NPD

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208390400000",
    "number": "1720006828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 PRUDENTIAL DR STE 713",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078209",
            "telephone_number": "904-396-5682",
            "fax_number": "904-346-0864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 PRUDENTIAL DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078202",
            "telephone_number": "904-396-5682",
            "fax_number": "904-346-0864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTECKI",
        "first_name": "CARISSA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "FL",
            "license": "ME85233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265150500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "29056",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000960352A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Harry M Koslowski, MD
• Bilal Kosovac, MS, LMHC, NCC
• Anastasia Dionne Kosowski
• Kim Kossakowski
• Semaan Georges Kosseifi, M.D.
• David A Kostick, MD
• Alexandra M Kostur, M.D.
• Mariya Kotova, PHARMD
• Allison Winfrey Kotowski, LCSW
• Kathryn B. Kott, APRN

• Pediatric Emergency Medicine (Pediatrics) Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatric Emergency Medicine (Pediatrics) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; 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.