Kristine Jenny Tibavisky, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

ME136019 Issued in FL

Practice address

653-1 W 8TH St
Jacksonville, FL 32209-6511

Phone

(904) 383-1037

Fax

(904) 244-6656

NPI assigned

Apr 2, 2014

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

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

Specialty

Obstetrics/Gynecology

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vitalmd Group Holding LLCGroup PAC ID 8921091786, 535 clinicians

Cora Health Services IncGroup PAC ID 1759290992, shared by 21 NPIs, 1,125 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Boca Raton Regional Hospital Hospital, Boca Raton, FL, CCN 100168

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Vitalmd Group Holding LLC

  • Obstetrics & Gynecology Physician
  • Miami, FL
  • NPI 1871572032
  Medicare reassignment Care Compare group NPD
• Womens Healthcare Assoc PA

  • Obstetrics & Gynecology Physician
  • Boca Raton, FL
  • NPI 1841287349
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Boca Raton Regional Hospital, Inc.

  • General Acute Care Hospital
  • Boca Raton, FL
  • NPI 1902826779
  Care Compare affiliation

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

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1851719124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653-1 W 8TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-383-1037",
            "fax_number": "904-244-6656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653-1 W 8TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-383-1037",
            "fax_number": "904-244-6656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBAVISKY",
        "first_name": "KRISTINE",
        "middle_name": "JENNY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-02",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME136019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Myint M Thway, MD
• Thyroid Diabetes Endocrinology and Wellness Inc
• Tia Dwana Collection LLC
• Sophia Nilen Tial
• Jinsong Tian, AP
• Kylee Lynn Tibbetts, PTA
• Morgan Tibbo, DO
• Kendra J Tice, RN, MSN,DNP
• Mary Tice, PA
• Tidajay Care Services Inc

• Obstetrics & Gynecology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Obstetrics & Gynecology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.