NPIMap

Organization Active NPI

Psychiatric Consultants of Central Florida, LLC

  • Behavioral Neurology & Neuropsychiatry Physician
  • Kissimmee, FL
National Provider Identifier
1174951891
Registry record updated Oct 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X
License
ME 115004 Issued in FL
Legal business name
PSYCHIATRIC CONSULTANTS OF CENTRAL FLORIDA, LLC
Practice address
3389 W Vine St
Suite 304
Kissimmee, FL 34741-4665
Phone
(407) 962-7449
Fax
(407) 563-5491
NPI assigned
Oct 15, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2013

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

Authorized official

Name
Ajith Kumar Potluri, M.D.NPI 1194791392
Title
Owner
Phone
(407) 962-7449

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavioral Neurology & Neuropsychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084B0040X ME 115004 FL Primary
Geriatric Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0805X ME 115004 FL

Addresses

Primary practice location

3389 W Vine St
Suite 304
Kissimmee, FL 34741-4665

Mailing address

3389 W Vine St
Suite 304
Kissimmee, FL 34741-4665
Phone (407) 962-7449

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131031000561 FL Part B Supplier - Clinic/Group Practice 0749415644 Receives reassigned benefits from 6 practitioners
Practice locations: Kissimmee, FL

National Provider Directory

National Provider Directory

Locations

3389 W Vine St
Ste 304
Kissimmee, FL 34741
Phone (407) 932-2799

3391 W Vine St
Ste 303
Kissimmee, FL 34741
Phone (407) 962-7449

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1381795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381795200000",
    "number": "1174951891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3389 W VINE ST",
            "address_2": "SUITE 304",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414665",
            "telephone_number": "407-962-7449",
            "fax_number": "407-563-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3389 W VINE ST",
            "address_2": "SUITE 304",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414665",
            "telephone_number": "407-962-7449",
            "fax_number": "407-563-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRIC CONSULTANTS OF CENTRAL FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-15",
        "last_updated": "2013-10-15",
        "status": "A",
        "authorized_official_last_name": "POTLURI",
        "authorized_official_first_name": "AJITH",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-962-7449",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "FL",
            "license": "ME 115004",
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "FL",
            "license": "ME 115004",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.