John Koleth, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD421215 Issued in PA

Practice address

769 W Blaine St
Riverside, CA 92507-3970

Phone

(951) 358-4705

NPI assigned

Nov 9, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/9357/brand/1/csg/1/fhir/r4

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.

• Mellow Medical Inc a Professional Corporation

  • Psychiatry Physician
  • West Hollywood, CA
  • NPI 1407275886
  Medicare reassignment NPD
• Hlca, Inc.

  • Psychiatry Physician
  • West Hollywood, CA
  • NPI 1437585882
  NPD
• Hispanic Community Counseling Services

  • Community/Behavioral Health Agency
  • Philadelphia, PA
  • NPI 1194876052
  NPD (past)

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

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635724800000",
    "number": "1902086770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S 31ST ST",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191463506",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "769 W BLAINE ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925073970",
            "telephone_number": "951-358-4705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5501 Woodland Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191435607",
            "country_code": "US",
            "telephone_number": "215-724-4700",
            "fax_number": "215-724-3111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2085 Rustin Ave",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925072498",
            "country_code": "US",
            "telephone_number": "951-955-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLETH",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-09",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD421215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan Koerper, LCSW
• Alexander Yoo-Ahng Koh, D.D.S.
• Janet Elizabeth Kohtz, O.D.
• Erfan Kohzadi
• Dorothy Naomi Kolb-Kishaba, LMFT
• Erwin Kong
• Fernando Kong
• Vincent Kong, DO
• David Anthony Konzem, PA-C
• Chulhwe Koo, M.D.

• Psychiatry Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.