JACK PETER KOTLARZ MD
NPI 1922090646
Otolaryngology - Plastic Surgery within the Head & Neck in Rockford, IL

Q: What is Jack Kotlarz's NPI number?

The NPI number for Jack Kotlarz is 1922090646. It was assigned to this individual provider in the NPPES registry on August 18, 2005.

Q: What is Jack Kotlarz's specialty?

The primary specialty registered for this NPI is Otolaryngology, specializing in Plastic Surgery within the Head & Neck, with taxonomy code 207YX0007X.

Q: When was this NPI record last updated?

The NPPES record for Jack Kotlarz was last updated on December 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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.

Active since August 18, 2005PECOS EnrolledAccepts Medicare Assignment

75/100

CMS Quality Rating

1253 N ALPINE RD, ROCKFORD, IL 61107(779) 696-9201(815) 397-9667 Get Directions Write a Review

NPPES record last updated: December 10, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 10, 2024, Sep 18, 2024, Sep 5, 2024 (3 updates tracked since 2024).

On this page

About Jack Peter Kotlarz Md NPPES

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

JACK PETER KOTLARZ MD (NPI 1922090646) is an individual plastic surgery within the head & neck provider in Rockford, Illinois, licensed in Illinois (036170362) and active in the NPI registry since August 2005. He is enrolled in Medicare PECOS, is affiliated with Marion Communtiy Hospital, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1922090646

Entity TypeIndividualMale

Primary Taxonomy207YX0007X

Provider Legal NameJACK PETER KOTLARZCredential: MD

Location Address1253 N ALPINE RDRockford, IL 61107-2201

Mailing Address6100 North Davis HwyPensacola, FL 32504-6950 · (850) 471-2377 · Fax (850) 471-9975

Phone(779) 696-9201

Fax(815) 397-9667

Sole ProprietorYes

Medical School CMSUniversity Of Illinois College Of Med (chi/peor/rock/chm-urb)Graduated 1987

Enumeration DateAugust 18, 2005

Last NPPES UpdateDecember 10, 20243 updates tracked since enumeration

NPPES CertifiedDecember 10, 2024

✔ NPI 1922090646 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyOtolaryngology · Plastic Surgery within the Head & NeckAllopathic & Osteopathic Physicians

Taxonomy Code207YX0007X

License✔ Licensed in IL · 036170362

Definition

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.

Also ListedSpecialistTaxonomy 174400000X · License ME62757 (FL)

Also ListedOtolaryngologyTaxonomy 207Y00000X · License ME62757 (FL), 2024013411 (MO)

1253 N ALPINE RD, Rockford, IL 61107

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Secondary Practice Locations 2

Location 13100 E Fletcher AveTampa, FL 33613-4613 · Phone (813) 971-6000 · Fax (813) 615-7542

Location 26100 NORTH DAVIS HWYPensacola, FL 32504-6950 · Phone (850) 471-2377 · Fax (850) 471-9975

Other Identifiers 7

Other4314144FL · Aetna

Other7618346003FL · Cigna Ppo

Other009900475AL · Medicaid Ala

Other040016528FL · Uhc Mcr Rr

Other590 51780AL · Bcbs Of Ala

Medicaid253548300FL

Other42544FL · Bcbs Of Florida

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter of Alabama, AvMed and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jack Peter Kotlarz Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6709934664

PECOS Enrollment IDI20090501000460

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Jack Kotlarz reassigns Medicare billing to 6 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Swedishamerican Hospital

Same address

Endocrinology, Diabetes & Metabolism

1253 N ALPINE RD
Rockford, IL 61107

Reassigned Medicare billing, Illinois enrollment
474 clinicians in this Medicare group

NPI 1144382268 (779) 696-9201

Mosaic Medical Center - Maryville

332 mi

Specialist

2016 S MAIN ST
Maryville, MO 64468

Reassigned Medicare billing, Missouri enrollment
341 clinicians in this Medicare group

NPI 1184189797 (660) 562-2525

Heartland Regional Medical Center

346 mi

General Practice

5325 FARAON ST
Saint Joseph, MO 64506

Reassigned Medicare billing, Missouri enrollment
471 clinicians in this Medicare group

NPI 1477575405 (816) 271-6000

Phoebe Gastroenterology Associates

782 mi

Clinic/Center

2740 RAY KNIGHT WAY, STE 100
Albany, GA 31707

Reassigned Medicare billing, Georgia enrollment
Medicare enrollment name: Phoebe Physician Group Inc
1,118 clinicians in this Medicare group

NPI 1659627131 (229) 312-0669

Ocala Health Surgical Group LLC

983 mi

Thoracic Surgery (Cardiothoracic Vascular Surgery)

4600 SW 46TH CT, SUITE 250
Ocala, FL 34474

Reassigned Medicare billing, Florida enrollment
52 clinicians in this Medicare group

NPI 1659540524 (352) 291-2400

Florida Hospital Physician Group Inc

1,048 mi

Family Medicine

3000 MEDICAL PARK DR, STE 320
Tampa, FL 33613

Reassigned Medicare billing, Florida enrollment
1,719 clinicians in this Medicare group

NPI 1174955256 (813) 336-5766

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Marion Communtiy Hospital

Acute Care Hospitals · Ocala, FL

1/5 CMS rating

OwnershipProprietary

CMS Certification Number100212

Location1431 SW 1st AveOcala, FL 34471 · Marion County

Emergency services

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

75/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Individually scored

Reported Quality Measures

Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy - Avoidance of Inappropriate Use

Percentage of patients aged 2 years and older with a diagnosis of AOE who were not prescribed systemic antimicrobial therapy

87%46 patients

Acute Otitis Externa (AOE): Topical Therapy

Percentage of patients aged 2 years and older with a diagnosis of AOE who were prescribed topical preparations

79%47 patients4/55-star benchmark: 100%

Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse)

Percentage of patients aged 18 years and older with a diagnosis of acute sinusitis who had a computerized tomography (CT) scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis

Lower rates are better for this measure.

0%131 patients

e-Prescribing

At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.

99%1,053 patients4/55-star benchmark: 100%

Medication Reconciliation

The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.

7%672 patients1/55-star benchmark: 100%

Patient-Specific Education

The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.

98%2,158 patients4/55-star benchmark: 100%

Pneumococcal Vaccination Status for Older Adults

Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine

58%2,009 patients3/55-star benchmark: 95%

Provide Patient Access

At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…

98%2,272 patients4/55-star benchmark: 100%

Secure Messaging

For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…

0%2,272 patients1/55-star benchmark: 79%

Tobacco Use and Help with Quitting Among Adolescents

The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for whom tobacco use status was documented and received help with quitting if identified as a tobacco user

94%114 patients

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 12

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Tubing with integrated heating element for use with positive airway pressure device A4604

DME-Other DME · category DE001N

5 suppliers23 claims23 services$37.89 avg. paid by Medicare

Full face mask used with positive airway pressure device, each A7030

DME-Other DME · category DE001N

5 suppliers25 claims25 services$94.59 avg. paid by Medicare

Face mask interface, replacement for full face mask, each A7031

DME-Other DME · category DE001N

5 suppliers25 claims73 services$35.96 avg. paid by Medicare

Cushion for use on nasal mask interface, replacement only, each A7032

DME-Other DME · category DE001N

5 suppliers23 claims117 services$20.37 avg. paid by Medicare

Pillow for use on nasal cannula type interface, replacement only, pair A7033

DME-Other DME · category DE001N

6 suppliers27 claims147 services$14.34 avg. paid by Medicare

Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034

DME-Other DME · category DE001N

6 suppliers48 claims48 services$56.60 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

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

DR. AMRUTHA MARY GEORGE M.D.

Internal Medicine (Endocrinology, Diabetes & Metabolism)