1. Home
  2. Directory
  3. Florida
  4. St Augustine
  5. Dentist
  6. NPI Profile

DR. JESSICA KOSTER DDS
NPI 1508590647
Dentist - Periodontics in St Augustine, FL

Active since July 14, 2022Opted out of Medicare · through Sep 17, 2027
10 SAINT JOHNS MEDICAL PARK DR STE C, ST AUGUSTINE, FL 32086(210) 450-3715 Get Directions Write a Review

NPPES record last updated: April 29, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Jessica Koster Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JESSICA KOSTER DDS (NPI 1508590647) is an individual periodontics provider in St Augustine, Florida, licensed in Florida (DN29830) and active in the NPI registry since July 2022. She has opted out of Medicare through September 17, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1508590647
Entity TypeIndividualFemale
Primary Taxonomy1223P0300X
Provider Legal NameDR. JESSICA KOSTERCredential: DDS
Location Address10 SAINT JOHNS MEDICAL PARK DR STE CSt Augustine, FL 32086-5202
Mailing Address130 Shipyard Way Apt 1436Saint Augustine, FL 32084-4233 · (214) 608-8046
Phone(210) 450-3715
Sole ProprietorYes
Enumeration DateJuly 14, 2022
Last NPPES UpdateApril 29, 2025
NPPES CertifiedApril 29, 2025
✔ NPI 1508590647 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in FL · DN29830
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
Also ListedDentistTaxonomy 122300000X · License 38796 (TX)
10 SAINT JOHNS MEDICAL PARK DR STE C, St Augustine, FL 32086
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jessica Koster Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 17, 2025 through September 17, 2027.

Opt-Out Effective DateSeptember 17, 2025
Opt-Out In Effect ThroughSeptember 17, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32086 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$87.62 typical visit price
range $56.00 – $171.84
Typical copayment $21.90 (range $14.00 – $42.96)
Most-billed visit code 99203
Established Patient
$70.04 typical visit price
range $17.57 – $139.16
Typical copayment $17.51 (range $4.39 – $34.79)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ROBERT EV KELLEY III D.M.D., M.S.
Dentist (Periodontics)
10 SAINT JOHNS MEDICAL PARK DR STE C
SAINT AUGUSTINE, FL 32086
St. Johns County (904) 467-5507
DR. HAILEY WILSON MCKINLEY DDS, MSD
Dentist (Periodontics)
10 SAINT JOHNS MEDICAL PARK DR STE C
ST AUGUSTINE, FL 32086
St. Johns County (904) 794-1000
FLORIDA SEDATION, IMPLANT AND DENTAL SURGERY ASSOCIATES, LLC
Dentist (Periodontics)
10 SAINT JOHNS MEDICAL PARK DR STE C
SAINT AUGUSTINE, FL 32086
St. Johns County (904) 794-1000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jessica Koster's NPI number?

The NPI number for Jessica Koster is 1508590647. It was assigned to this individual provider in the NPPES registry on July 14, 2022.

Where is Jessica Koster located?

Jessica Koster practices at 10 Saint Johns Medical Park Dr Ste C, St Augustine, FL 32086. The listed phone number is (210) 450-3715.

What is Jessica Koster's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Is Jessica Koster enrolled in Medicare?

No. Jessica Koster has opted out of Medicare through September 17, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jessica Koster was last updated on April 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.