NPIMap

Individual provider Active NPI

Ravi Kotha, MD

  • Emergency Medicine Physician
  • Crystal City, MO
National Provider Identifier
1770526584
Registry record updated Jan 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2003021689 Issued in MO
Practice address
Hwy 61 South
Crystal City, MO 63019
Phone
(904) 805-1300
Fax
(904) 805-1302
NPI assigned
Jun 13, 2006
Last updated
Jan 28, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2003021689 MO Primary

Addresses

Primary practice location

Hwy 61 South
Crystal City, MO 63019

Mailing address

PO Box 827431
Philadelphia, PA 19182-7431
Phone (904) 805-1300

Other identifiers 6

IdentifierTypeStateIssuer
124884OtherMOBLUE CROSS
947071631OtherMOMERCY HEALTH
P00066451OtherMORAILROAD MEDICARE
426403OtherMOHEALTHLINK
208824110MedicaidMO
222382593OtherMOCHAMPUS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
BC Missouri Emergency Physicians, LLP Emergency Medicine Past Accepting new patients
Phelps Memorial Hospital Association Past Accepting new patients
BC Progress Emergency Physicians, LLP Emergency Medicine Past Accepting new patients
Hudson Valley Emergency Medicine PLLC Past Accepting new patients
Southeastern Emergency Physicians of Memphis LLC Emergency Medicine Past Accepting new patients
Phelps Memorial Hospital Association Emergency Medicine Past Accepting new patients
North County Emergency Physicians, LLP Emergency Medicine Past Accepting new patients
Advocate Health and Hospitals Corporation Past Accepting new patients
BC Missouri Emergency Physicians, LLP Emergency Medicine Past Accepting new patients
BC Missouri Emergency Physicians, LLP Emergency Medicine Past Accepting new patients
Suburban Medical Associates, S.C. PastSince Apr 1, 2008 Accepting new patients
Crystal City Emergency Services, LLC Emergency Medicine Past Accepting new patients

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296172800000",
    "number": "1770526584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 827431",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191827431",
            "telephone_number": "904-805-1300",
            "fax_number": "904-805-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 61 SOUTH",
            "city": "CRYSTAL CITY",
            "state": "MO",
            "postal_code": "63019",
            "telephone_number": "904-805-1300",
            "fax_number": "904-805-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTHA",
        "first_name": "RAVI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2011-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2003021689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "124884",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY HEALTH",
            "identifier": "947071631",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00066451",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "426403",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208824110",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "222382593",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.