NPIMap

Individual provider Active NPI

Pothen C Koruth, MD

  • Internal Medicine Physician
  • Lake Mary, FL
National Provider Identifier
1093768400
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME0072112 Issued in FL
Practice address
758 N Sun Dr
St # 104
Lake Mary, FL 32746-2599
Phone
(407) 333-3303
Fax
(407) 333-3342
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X ME0072112 FL
Internal Medicine Physician 207R00000X ME0072112 FL Primary

Addresses

Primary practice location

758 N Sun Dr
St # 104
Lake Mary, FL 32746-2599

Mailing address

758 N Sun Dr
St # 104
Lake Mary, FL 32746-2599
Phone (407) 333-3303

Other identifiers 1

IdentifierTypeStateIssuer
269423900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041201001091 FL Practitioner - Internal Medicine 0042276065 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians

Practice addresses (Care Compare)

1200 Lexington Green LN
Sanford, FL 32771-1013

758 N Sun Dr
Suite 104
Lake Mary, FL 32746-2599
Phone (407) 333-3303

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0072112FLMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Pothen Koruth MD LLC CurrentSince Apr 1, 2004 Accepting new patients
Florida Medical Associates LLC Past Accepting new patients

Locations

758 N Sun Dr
Ste 104
Lake Mary, FL 32746
Phone (407) 333-3303

758 N Sun Dr
Ste 104A
Lake Mary, FL 32746

Organizations & group practices 2

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647388800000",
    "number": "1093768400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "758 N SUN DR",
            "address_2": "ST # 104",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462599",
            "telephone_number": "407-333-3303",
            "fax_number": "407-333-3342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 N SUN DR",
            "address_2": "ST # 104",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462599",
            "telephone_number": "407-333-3303",
            "fax_number": "407-333-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORUTH",
        "first_name": "POTHEN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME0072112",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0072112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269423900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.