Pothen Koruth MD LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

POTHEN KORUTH MD LLC

Practice address

758 N Sun Dr
Lake Mary, FL 32746-2599

Phone

(407) 333-3303

Fax

(407) 333-3342

NPI assigned

Feb 13, 2008

Organization subpart

No

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

Authorized official

Name

Carolyn Victoria Brown

Title

Office Manager

Phone

(407) 333-3303

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pothen C Koruth, MD

  • Internal Medicine Physician
  • Lake Mary, FL
  • NPI 1093768400
  Medicare reassignment NPD

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202860800000",
    "number": "1154599132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "758 N SUN DR",
            "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",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462599",
            "telephone_number": "407-333-3303",
            "fax_number": "407-333-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTHEN KORUTH MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2008-02-13",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "VICTORIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "407-333-3303"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Exclusive Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.