Jessica D Kotik, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1891 Issued in SC

Practice address

200 Patewood Dr Ste A200
Greenville, SC 29615-3580

Phone

(864) 454-5115

Fax

(864) 241-9205

NPI assigned

Aug 13, 2024

Last updated

Sep 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prisma Health University Medical Group

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295763217
  Medicare reassignment NPD
• Prisma Health University Medical Group

  dba Parkside OB-GYN

  • Gynecology Physician
  • Greer, SC
  • NPI 1003619313
  NPD

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

{
    "created_epoch": "1723507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1841021417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-695-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR STE A200",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153580",
            "telephone_number": "864-454-5115",
            "fax_number": "864-241-9205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTIK",
        "first_name": "JESSICA",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-13",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "SC",
            "license": "1891",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "SC",
            "license": "1891",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Joseph Kosmicki, D.C.
• Clare Koss
• Sherry Sue Kostman, PSY.D.
• Shanu Nikhil Kothari, MD
• McKenzie Kothe
• Spyros A Koutsioukis, DMD
• Dmitri Kovalev, M.D.
• Alexander Kovalic, MD
• Linda Lou Kowalczyk
• Keith Frederick Kraemer, MD

• Psychologist in Greenville, SC
• Providers in Greenville, SC by specialty
• Psychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; 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.