Four Corners Internal Medicine, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

ME78339 Issued in FL

Legal business name

FOUR CORNERS INTERNAL MEDICINE, LLC

Practice address

106 Polo Park East Blvd
Davenport, FL 33897-9407

Phone

(863) 424-8900

Fax

(863) 424-8823

NPI assigned

May 24, 2006

Last updated

Oct 20, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Srinath Reddy Kosanam, MDNPI 1154313476

Title

Owner

Phone

(863) 424-8900

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BDCADD

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Srinath Reddy Kosanam, M.D

  • Internal Medicine Physician
  • Davenport, FL
  • NPI 1154313476
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287532800000",
    "number": "1346295466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10603 EMERALD CHASE DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328365855",
            "telephone_number": "407-217-5353",
            "fax_number": "407-217-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 POLO PARK EAST BLVD",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338979407",
            "telephone_number": "863-424-8900",
            "fax_number": "863-424-8823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS INTERNAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2010-10-20",
        "status": "A",
        "authorized_official_last_name": "KOSANAM",
        "authorized_official_first_name": "SRINATH",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-424-8900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "ME78339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yocelin J Fonseca, BT
• Marshaun Ford, PHARM D
• Tiffany Alexandria Foster-Hammonds, PHARMD
• Craig Hopeton Foster, DDS
• K Wade Foster, MD, PA
• Four Corners Medical Center, LLC
• Four Corners Rehab & Wellness PL
• Brenda Francis, LM. CPM.
• Kepler Francois, DPT
• Irine Franelus

• Clinic/Center in Davenport, FL
• Providers in Davenport, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; 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.