Kick Some Mass, LLC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

Legal business name

KICK SOME MASS, LLC

Practice address

316 Parkridge Ave
Orange Park, FL 32065-7507

Phone

(904) 589-0750

NPI assigned

Jul 7, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey Allyn Ruterbusch

Title

Medical Director

Phone

(904) 505-0628

Specialties & licenses 4

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761091200000",
    "number": "1841673928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 PARKRIDGE AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320657507",
            "telephone_number": "904-589-0750",
            "fax_number": "904-621-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 PARKRIDGE AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320657507",
            "telephone_number": "904-589-0750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KICK SOME MASS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-07",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A",
        "authorized_official_last_name": "RUTERBUSCH",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ALLYN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "904-505-0628",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083B0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "IP327A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Shivam Khosla, DO
• Lyubov Khvan
• Daniel Kiehl, DO
• Rebecca Kiehl
• Caroline Kiely
• Audrey W Kilgore, BS, TCM, MMHC, CCC
• James R Kimberly Jr., M.D.

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.