Jaroslaw Lucas Koberda, M.D., PHD, NEUROLOGY

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

ME88946 Issued in FL

Practice address

4838 Kerry Forest Pkwy
Tallahassee, FL 32309-2272

Phone

(850) 877-2802

Fax

(850) 222-1383

NPI assigned

Jun 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23008/brand/1/csg/1/fhir/r4

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.

• Premier Medical Clinic

  • Internal Medicine Physician
  • Perry, FL
  • NPI 1518926799
  NPD (past)

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1972548279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4838 KERRY FOREST PKWY",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323092272",
            "telephone_number": "850-877-2802",
            "fax_number": "850-222-1383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4838 KERRY FOREST PKWY",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323092272",
            "telephone_number": "850-877-2802",
            "fax_number": "850-222-1383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBERDA",
        "first_name": "JAROSLAW",
        "middle_name": "LUCAS",
        "name_prefix": "Dr.",
        "credential": "M.D., PHD, NEUROLOGY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME88946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ECFMG",
            "identifier": "04795803",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zachary Tyler Knowles
• Ciele Knox
• Matthew Knox, CAA
• Sydney S Knutson, RBT
• Fang Sarah Ko, MD
• Brandi Shanell Koch, RNFA
• Anna Thomas Koeppel, MD
• Mary Anne Koeppel, A.R.N.P.
• Michael J. Kofler, PH.D.
• Hari K. Kolli, M.B.B.S. (M.D.)

• Neurology Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Neurology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.