Kohut Psychiatric Medical Group Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

KOHUT PSYCHIATRIC MEDICAL GROUP INC

Practice address

1800 Medical Center Drive
Suite 300
San Bernardino, CA 92411

Phone

(909) 887-6222

Fax

(909) 887-4565

NPI assigned

Jul 19, 2006

Organization subpart

No

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

Authorized official

Name

John Joel Kohut, MD

Title

Psychiatry

Phone

(909) 887-6222

Specialties & licenses 4

Addresses

Other identifiers 2

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498089600000",
    "number": "1245259258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 MEDICAL CENTER DRIVE",
            "address_2": "SUITE 300",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92411",
            "telephone_number": "909-887-6222",
            "fax_number": "909-887-4565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 MEDICAL CENTER DRIVE",
            "address_2": "SUITE 300",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92411",
            "telephone_number": "909-887-6222",
            "fax_number": "909-887-4565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOHUT PSYCHIATRIC MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2017-06-22",
        "status": "A",
        "authorized_official_last_name": "KOHUT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JOEL",
        "authorized_official_title_or_position": "PSYCHIATRY",
        "authorized_official_telephone_number": "909-887-6222",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ59319Z",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "GR0040560",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Knotts Family Agency
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• Gwendolyn K Knotts
• Jessa Marie Koch, PHARMD
• Christian Koeu
• Koinonia Foster Homes, Inc.
• Nikhitha Konda, M.D.
• Kooley Transportation
• Sakorn Koonopakarn, M.D.
• Arputharaj Higgins Kore, MD

• All providers in San Bernardino, CA
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.