Ivan Ronald Koota, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

097360 Issued in NY

Practice address

337 Collins Ter
Delhi, NY 13753-1402

Phone

(607) 746-8122

NPI assigned

Mar 19, 2012

Last updated

Mar 19, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

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

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332115200000",
    "number": "1992070312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "337 COLLINS TER",
            "city": "DELHI",
            "state": "NY",
            "postal_code": "137531402",
            "telephone_number": "607-746-8122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "337 COLLINS TER",
            "city": "DELHI",
            "state": "NY",
            "postal_code": "137531402",
            "telephone_number": "607-746-8122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOTA",
        "first_name": "IVAN",
        "middle_name": "RONALD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-19",
        "last_updated": "2012-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "097360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE  NUMBER",
            "identifier": "097360",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Austin Kilmer
• Erin Emily Kingsbury, PHARM. D.
• Patricia Marie Knapp, LPN
• Jennifer Lynn Kollig, CCC-SLP
• Dawn Louise Komosinski, LPN
• Victoria Kramp, LAT, ATC
• Jodi L Krzyston, RN
• Leatherstocking Healthcare LLC (Countryside Care Center)
• Amanda Nichole Lewis, M.S., CCC-SLP
• Carol Little, MA

• Family Medicine Physician in Delhi, NY
• Providers in Delhi, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2012; 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.