Jack Peter Kotlarz, MD

Primary specialty

Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X

License

036170362 Issued in IL

Practice address

1253 N Alpine Rd
Rockford, IL 61107-2201

Phone

(779) 696-9201

Fax

(815) 397-9667

NPI assigned

Aug 18, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in FL, IL, MO, GA4 enrollments

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 4

Specialty

OtolaryngologyAlso: Plastic and Reconstructive Surgery

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ocala Health Surgical Group LLCGroup PAC ID 4082787130, 51 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Marion Communtiy Hospital Hospital, Ocala, FL, CCN 100212

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Merit-based Incentive Payment System (MIPS)

Final score

89.82 of 100Reported as group

Quality

86.45

Promoting interoperability

99

Improvement activities

40

Cost

66.39

Merit-based Incentive Payment System (MIPS)

Final score

81.51 of 100Reported as group

Quality

83.2

Promoting interoperability

77

Improvement activities

40

Cost

71.7

Merit-based Incentive Payment System (MIPS)

Final score

84.76 of 100Reported as group

Quality

74.35

Promoting interoperability

100

Improvement activities

40

Cost

74.85

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

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.

• Ocala Health Surgical Group LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Ocala, FL
  • NPI 1659540524
  Medicare reassignment Care Compare group NPD
• Swedishamerican Hospital

  • Family Medicine Physician
  • Rockford, IL
  • NPI 1962451732

  Otolaryngology

  Medicare reassignment NPD
• Florida Hospital Physician Group Inc

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1174955256

  Otolaryngology

  Medicare reassignment NPD
• Heartland Regional Medical Center

  • General Practice Physician
  • Saint Joseph, MO
  • NPI 1477575405

  Otolaryngology

  Medicare reassignment NPD
• Mosaic Medical Center - Maryville

  • Specialist
  • Maryville, MO
  • NPI 1184189797
  Medicare reassignment NPD
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  Medicare reassignment NPD
• Swedishamerican Hospital

  • Community/Retail Pharmacy
  • Rockford, IL
  • NPI 1306635982
  NPD
• Swedishamerican Hospital

  • Orthopaedic Surgery Physician
  • Rockford, IL
  • NPI 1972706851
  NPD
• Heartland Regional Medical Center

  • General Practice Physician
  • Saint Joseph, MO
  • NPI 1538200357

  Otolaryngology

  NPD
• Heartland Regional Medical Center

  • Rehabilitation Hospital Unit
  • Saint Joseph, MO
  • NPI 1841385093
  NPD
• Mosaic Medical Center - Maryville

  • Psychiatric Hospital Unit
  • Maryville, MO
  • NPI 1477027803
  NPD
• ENT Associates of N.W. Florida, PA

  • Otolaryngology Physician
  • Pensacola, FL
  • NPI 1235106733
  NPD (past)

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

• Marion Community Hospital, Inc.

  • General Acute Care Hospital
  • Ocala, FL
  • NPI 1841237930
  Care Compare affiliation

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1922090646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 NORTH DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325046950",
            "telephone_number": "850-471-2377",
            "fax_number": "850-471-9975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1253 N ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611072201",
            "telephone_number": "779-696-9201",
            "fax_number": "815-397-9667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3100 E Fletcher Ave",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336134613",
            "country_code": "US",
            "telephone_number": "813-971-6000",
            "fax_number": "813-615-7542",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6100 NORTH DAVIS HWY",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325046950",
            "country_code": "US",
            "telephone_number": "850-471-2377",
            "fax_number": "850-471-9975",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTLARZ",
        "first_name": "JACK",
        "middle_name": "PETER",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME62757",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME62757",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MO",
            "license": "2024013411",
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "IL",
            "license": "036170362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4314144",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PPO",
            "identifier": "7618346003",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID ALA",
            "identifier": "009900475",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC MCR RR",
            "identifier": "040016528",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ALA",
            "identifier": "590 51780",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253548300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "42544",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Radhika Kosaraju, MD
• Nidhi Bakul Kotak, D.D.S.
• Jane Lynn Kotecki, MD
• Gary T. Koteles, OD
• Azhar Kothawala, M.D.
• Steven Kouris, DO
• Emily N Kozak, NP
• Alexis N Kozlowski, APRN, FNP-BC
• KP Counseling LTD
• Bonnie Kraft, LCSW

• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Illinois

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