NPIMap

Individual provider Active NPI

Jacob S Koruth, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • New York, NY
National Provider Identifier
1265652051
Registry record updated Jul 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
003848 Issued in NY
Practice address
1190 5TH Ave
New York, NY 10029-6503
Phone
(212) 427-1540
Fax
(212) 241-9701
NPI assigned
Apr 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 23894 NE
Clinical Cardiac Electrophysiology Physician 207RC0001X 003848 NY Primary

Addresses

Primary practice location

1190 5TH Ave
New York, NY 10029-6503

Mailing address

1190 5TH Ave
New York, NY 10029-6503
Phone (212) 427-1540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20110817000202 NY Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology) 1153590757 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1 Gustave L Levy PL
New York, NY 10029-6504
Phone (212) 731-7822

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair22

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
003848NYMDAcupuncturist
23894NEMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 1, 2012 Accepting new patients
Icahn School of Medicine at Mount Sinai Cardiovascular Disease CurrentSince Aug 1, 2012 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Bon Secours Charity Health System Medical Group, P.C. Past Accepting new patients
Mount Sinai Hospital Past Accepting new patients

Locations

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

1190 5th Ave
New York, NY 10029
Phone (212) 241-6756

150 E 42nd St
Fl 10
New York, NY 10017
Phone (646) 605-8119

1190 5th Ave
Fl 1
New York, NY 10029

10114 Liberty Ave
Ozone Park, NY 11417
Phone (718) 487-3330

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722

Organizations & group practices 5

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 6

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": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310083200000",
    "number": "1265652051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 5TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296503",
            "telephone_number": "212-427-1540",
            "fax_number": "212-241-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 5TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296503",
            "telephone_number": "212-427-1540",
            "fax_number": "212-241-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORUTH",
        "first_name": "JACOB",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2011-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NE",
            "license": "23894",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NY",
            "license": "003848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.