Laurel Diane Kortum, M.D.

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

0101240278 Issued in VA

Practice address

3620 Joseph Siewick Dr
Ste 202
Fairfax, VA 22033-1756

Phone

(703) 922-9501

NPI assigned

Jun 4, 2006

Last updated

Mar 5, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in VA, DC2 enrollments

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 2

Specialty

Anesthesiology

Education

University of Nebraska College of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Inova Cares - CommunityGroup PAC ID 9537526330, 187 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Inova Fair Oaks Hospital Hospital, Fairfax, VA, CCN 490101

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lkortum61111@soc.inova.org

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.

• Inova Cares - Community

  • Anesthesiology Physician
  • Fairfax, VA
  • NPI 1861131906

  DC

  Medicare reassignment Care Compare group NPD
• American Anesthesiology of Virginia PC

  • Anesthesiology Physician
  • Falls Church, VA
  • NPI 1417994872

  DC

  Medicare reassignment NPD
• American Anesthesiology of Virginia, PC

  • Anesthesiology Physician
  • Leesburg, VA
  • NPI 1053675199
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Inova Health Care Services

  dba Inova Fair Oaks Hospital

  • General Acute Care Hospital
  • Fairfax, VA
  • NPI 1760513980
  Care Compare affiliation

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425513600000",
    "number": "1295773729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3998 FAIR RIDGE DR",
            "address_2": "STE 300",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332921",
            "telephone_number": "703-766-9737",
            "fax_number": "703-766-9725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 JOSEPH SIEWICK DR",
            "address_2": "STE 202",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331756",
            "telephone_number": "703-922-9501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORTUM",
        "first_name": "LAUREL",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-04",
        "last_updated": "2015-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NE",
            "license": "TEP4621",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "VA",
            "license": "0101240278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPPO",
            "identifier": "484645",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "033579",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295773729",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE FIRST 2005",
            "identifier": "K142-0001",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "9445356",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Mark Koons, M.D.
• Anna Lee Koozmin, MSW, LCSW, LICSW
• Ana Veronica S Kopelman, PA-C
• David James Kopin, M.D.
• Amy Korcsmaros
• Alison K Korver, LMFT
• Leena Kosandal, M.D
• Caroline Koscheski
• Nathan Michael Kossey, PA
• Dariusz P. Kot, DDS

• Pain Medicine (Anesthesiology) Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Pain Medicine (Anesthesiology) Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; 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.