Active NPI
James Potocsnak, PAC
- Surgical Physician Assistant
- Everett, WA
National Provider Identifier
1003881020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA10001718
- Practice address
- 2320 Rucker Ave
Everett, WA 98201 - Phone
- (425) 259-5121
- Fax
- (425) 252-1322
- NPI assigned
- Feb 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA10001718 | WA | Primary |
Addresses
Primary practice location
2320 Rucker Ave
Everett, WA 98201
Mailing address
2320 Rucker Ave
Everett, WA 98201
Phone (425) 259-5121
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10001718 | WA | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195430400000",
"number": "1003881020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2320 RUCKER AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "98201",
"telephone_number": "425-259-5121",
"fax_number": "425-252-1322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2320 RUCKER AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "98201",
"telephone_number": "425-259-5121",
"fax_number": "425-252-1322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTOCSNAK",
"first_name": "JAMES",
"name_prefix": "Mr.",
"credential": "PAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-22",
"last_updated": "2007-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "WA",
"license": "PA10001718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.