Organization Active NPI

John Cottam MD PA

  • Dermatology Physician
  • Fort Walton Beach, FL
National Provider Identifier
1750057873
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
JOHN COTTAM MD PA
Practice address
1032 Mar Walt Dr Unit 100
Fort Walton Beach, FL 32547-6661
Phone
(850) 424-1259
Fax
(813) 962-0566
NPI assigned
Aug 18, 2021
Last updated
Jul 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Authorized official

Name
Shawna Frame
Title
Billing Manager
Phone
(423) 525-5993

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

1032 Mar Walt Dr Unit 100
Fort Walton Beach, FL 32547-6661

Mailing address

14310 N Dale Mabry Hwy Ste 180
Tampa, FL 33618-2059
Phone (813) 962-4210

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL SKINMD@HOTMAIL.COM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080826000032 FL Part B Supplier - Clinic/Group Practice 6002981107 Receives reassigned benefits from 4 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tampa, FL; Sun City Center, FL; Lady Lake, FL; Fort Walton Beach, FL; Brandon, FL; Chiefland, FL; Bartow, FL; Bradenton, FL

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
John Cottam MD PA6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1032 Mar Walt Dr
Unit 100
Ft Walton Bch, FL 32547
Phone (850) 424-1259

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657670400000",
    "number": "1750057873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14310 N DALE MABRY HWY STE 180",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336182059",
            "telephone_number": "813-962-4210",
            "fax_number": "813-962-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 MAR WALT DR UNIT 100",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476661",
            "telephone_number": "850-424-1259",
            "fax_number": "813-962-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN COTTAM MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-18",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A",
        "authorized_official_last_name": "FRAME",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "423-525-5993"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "SKINMD@HOTMAIL.COM",
            "affiliation": "N",
            "address_1": "1032 Mar Walt Dr Unit 100",
            "city": "Fort Walton Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325476661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; 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.