Atoosa Kourosh, MD

Primary specialty

Pediatric Allergy/Immunology PhysicianTaxonomy code 2080P0201X

License

MD00044424 Issued in WA

Practice address

1170 N Carroll Ave
Southlake, TX 76092-5306

Phone

(214) 702-6550

Fax

(214) 894-4182

NPI assigned

Oct 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 7, 2023 through Feb 7, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: akourosh1186604@wm.providencedirect.org

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.

• Lone Star Circle of Care

  • Federally Qualified Health Center (FQHC)
  • Austin, TX
  • NPI 1699289728
  NPD (past)
• Shelby Naturopathy, PLLC

  • Medical Specialty Clinic/Center
  • Seattle, WA
  • NPI 1922359546
  NPD (past)

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1053401661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1170 N CARROLL AVE",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925306",
            "telephone_number": "214-702-6550",
            "fax_number": "214-894-4182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1170 N CARROLL AVE",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925306",
            "telephone_number": "214-702-6550",
            "fax_number": "214-894-4182"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5600 14th Ave NW",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981073723",
            "country_code": "US",
            "telephone_number": "206-919-0175",
            "fax_number": "206-567-9797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOUROSH",
        "first_name": "ATOOSA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00044424",
            "primary": false
        },
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "WA",
            "license": "MD00044424",
            "primary": true
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "WA",
            "license": "MD00044424",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE WVH",
            "identifier": "P01733874",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Portal",
            "affiliation": "N",
            "endpointDescription": "Cerbo",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4426 Burke Ave N",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981037536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emma Kolesky
• Kimberly Elaine Komon, PHD
• Kirk Justin Koogler, OD
• David E Kosmoski, MD
• Milan Kountz
• Thomas Kramer, DC
• Klaudia Krauszowska
• Meredith S Krebel, MD
• Krispr Inc
• Krista Kulesza, PH.D., LLC

• Pediatric Allergy/Immunology Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Pediatric Allergy/Immunology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.