Jeffrey John Kotulski, D.O.

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

37416 Issued in MN

Practice address

45 Teton Lane
Mankato, MN 56001

Phone

(507) 388-7488

Fax

(507) 388-5680

NPI assigned

Sep 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2014 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

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.

• Mayo Clinic Health System-Southwest Minnesota Region

  dba Mayo Clinic Health System - Mankato

  • Multi-Specialty Clinic/Center
  • Mankato, MN
  • NPI 1578545422
  NPD (past)
• Primary Specialists

  dba Center for Primary Care

  • Family Medicine Physician
  • Fairmont, MN
  • NPI 1588900864
  NPD (past)

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297987200000",
    "number": "1740386176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 TETON LANE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "507-388-7488",
            "fax_number": "507-388-5680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 TETON LANE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "507-388-7488",
            "fax_number": "507-388-5680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTULSKI",
        "first_name": "JEFFREY",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2011-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "MN",
            "license": "37416",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "37416",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "560320000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyce Lorayne Konz, LPN
• Rebecca Konz
• Tyler J Koonst, MD
• Naga Pradyumna Kothapalli, M.B.B.S.
• Erin Anastasia Kotten, MSW, LICSW
• Jessica Mae Koval, APRN CNP
• Eliana Kraay
• Ivaylo L Krastev, MD
• Alli Mae Krekelberg
• Sarah Jane Krenik-Hoffmann, SLP

• Neuromusculoskeletal Medicine & OMM Physician in Mankato, MN
• Providers in Mankato, MN by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.