Yakub Ahmed Pothiawala, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME 0070225 Issued in FL

Practice address

3865 Northdale Blvd
Tampa, FL 33624

Phone

(813) 960-4401

Fax

(813) 265-1258

NPI assigned

Jul 7, 2006

Last updated

Dec 14, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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.

Enrollment records 1

Specialty

Family Practice

Education

Other, 1985

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northdale Family Dr

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1285024380
  NPD (past) Authorized official
• MCR Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Parrish, FL
  • NPI 1255376000

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323820800000",
    "number": "1215969548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3865 NORTHDALE BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33624",
            "telephone_number": "813-960-4401",
            "fax_number": "813-265-1258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3865 NORTHDALE BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33624",
            "telephone_number": "813-960-4401",
            "fax_number": "813-265-1258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTHIAWALA",
        "first_name": "YAKUB",
        "middle_name": "AHMED",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2011-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME 0070225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "251408700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Potens Allergy LLC
• Potentia Therapeutics, LLC
• Mark Anthony Potesta Jr., DO
• Anita Pothen, PHARMD
• Salma Z Pothiawala, MD
• Victoria Marie Potocki, LMHC
• Sangy Paul Pottackal, M.D.
• Frederick Woodbridge Potter, MA
• Matthew Potter, PHARMD
• Xavier Potter, AU.D.

• Family Medicine Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; 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.
• 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.