JACK P. KOTLARZ MD – NPI #1922090646
Otolaryngology

An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.

JACK KOTLARZ is an otolaryngologist located in ROCKFORD, IL. NPPES has assigned the NPI number 1922090646 to JACK KOTLARZ on August 18, 2005. It is a Type-1 NPI, indicating this NPI number is associated with an individual. According to the NPI Registry, there are 2 additional location(s) assigned to this provider which are listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207YX0007X from the Health Care Provider Taxonomy code set, which is classified as Otolaryngology, specializing in Plastic Surgery within the Head & Neck

The NPI profile was last updated on Dec 10, 2024. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for JACK KOTLARZ below.

NPI Profile for
JACK P. KOTLARZ

NPI Number
1922090646
Enumeration Date

(about 21 years ago)
Entity Type
Type-1  Individual (Male)
Legal Name
JACK P. KOTLARZ
Credentials
MD
Primary location
1253 N ALPINE RD
ROCKFORD, IL 61107-2201
Phone: (779) 696-9201 Fax: (815) 397-9667
2 Other location(s):
6100 NORTH DAVIS HWY
Pensacola, FL 32504-6950
Phone: (850) 471-2377
Fax: (850) 471-9975
3100 E Fletcher Ave
Tampa, FL 33613-4613
Phone: (813) 971-6000
Fax: (813) 615-7542
Mailing address
6100 NORTH DAVIS HWY
PENSACOLA, FL 32504-6950
Phone: (850) 471-2377 Fax: (850) 471-9975
Sole Proprietor
Yes
Updated
Certification Date
Dec 10, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for JACK KOTLARZ

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

See identifiers
DescriptionIssuerStateIdentifier
otherAETNAFL4314144
otherBCBS OF ALAAL590 51780
otherBCBS OF FLORIDAFL42544
otherCIGNA PPOFL7618346003
otherMEDICAID ALAAL009900475
otherUHC MCR RRFL040016528
medicaidFL253548300
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207YX0007X
- Otolaryngology / Plastic Surgery within the Head & Neck (Primary)
IL 036170362
207Y00000X
- Otolaryngology
MO 2024013411
174400000X
- Specialist
FL ME62757

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Additional Information

Education
UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB) - Graduated 1987
Accepts Medicare
This provider accepts Medicare-approved amount as payment in full. The Medicare-approved amount is the total the provider can be paid. When a provider accepts the Medicare-approved amount as payment, you won't be billed for more than the Medicare deductible & coinsureance.
Medicare Ordering & Referring
Provider can:
  • Refer to Part B
  • Order Durable Medical Equipment
  • Refer to Home Health Agency
  • Order Power Mobility Devices
Affiliations
JACK KOTLARZ is affiliated with the following medical group(s):
  • HOSPITAL
    • BAPTIST HOSPITAL
      1000 W MORENO ST
      PENSACOLA, FL 32501
    • SACRED HEART HOSPITAL
      5151 N 9TH AVE
      PENSACOLA, FL 32504

Why is my NPI data (personal information) being displayed publicly?
If you have an active NPI profile, your profile is required to be disclosed according to the FOIA and eFOIA. HIPAA also requires covered providers to share their NPI with other providers, health plans, clearinghouses and any entity that may need it for billing purposes.

How do I correct or change the NPI data displayed here?
At any time, providers can make changes to their NPI profile at NPPES. Login to NPPES to make changes online or call (800) 465-3203 for assistance. Changes made at NPPES will be reflected on this web site within a few days.

Can I hide my NPI profile from the public?
Unfortunately, No. The NPPES discloses health care provider data under the Freedom of Information Act to the public, which means anyone may request such information directly from the National Plan & Provider Enumeration System. See the complete CMS Data Dissemination Notice here.