Individual provider Active NPI

Corey James Stotts, MD

  • Anesthesiology Physician
  • Dubuque, IA
National Provider Identifier
1619110426
Registry record updated Feb 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
41108 Issued in IA
Practice address
1440 S Grandview Ave
Dubuque, IA 52003-8733
Phone
(319) 290-2097
NPI assigned
Apr 8, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 51179 KY
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X 41108 IA Primary

Addresses

Primary practice location

1440 S Grandview Ave
Dubuque, IA 52003-8733

Mailing address

1440 S Grandview Ave
Dubuque, IA 52003-8733
Phone (319) 290-2097

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20230626002290 OR Practitioner - Anesthesiology 9032352497 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Iowa, RJ & L Carver College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oregon Anesthesiology Group PCGroup PAC ID 3476451659, 239 clinicians

Practice addresses (Care Compare)

4805 NE Glisan St
Portland, OR 97213-2933
Phone (503) 299-9906

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TP327KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Anesthesiology Group PC Anesthesiology CurrentSince Jun 5, 2023 Accepting new patients
Dodge Street Anesthesiologists PC Anesthesiology Past Accepting new patients

Locations

707 SW Washington St
Ste 700
Portland, OR 97205

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

Organizations & group practices 2

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 3

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": "1239148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675987200000",
    "number": "1619110426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 S GRANDVIEW AVE",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520038733",
            "telephone_number": "319-290-2097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 S GRANDVIEW AVE",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520038733",
            "telephone_number": "319-290-2097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOTTS",
        "first_name": "COREY",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-08",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": "51179",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IA",
            "license": "41108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dubuque, IA

Sources for this page

Verify at the official NPI Registry.