NPIMap

Individual provider Active NPI

Jerry Edward Potmesil I, RPH

  • Pharmacist
  • Sparks, NV
National Provider Identifier
1043623093
Registry record updated Jun 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
05137 Issued in NV
Practice address
2895 N McCarran Blvd
Sparks, NV 89431-1882
Phone
(775) 353-8818
Fax
(775) 353-8821
NPI assigned
Jun 7, 2014
Last updated
Jun 7, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 05137 NV Primary

Addresses

Primary practice location

2895 N McCarran Blvd
Sparks, NV 89431-1882

Mailing address

2895 N McCarran Blvd
Sparks, NV 89431-1882
Phone (775) 353-8818

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)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
05137NVMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Raleys Past Accepting new patients
Raleys Past Accepting new patients

Organizations & group practices 2

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": "1402099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402099200000",
    "number": "1043623093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2895 N MCCARRAN BLVD",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894311882",
            "telephone_number": "775-353-8818",
            "fax_number": "775-353-8821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2895 N MCCARRAN BLVD",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894311882",
            "telephone_number": "775-353-8818",
            "fax_number": "775-353-8821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTMESIL",
        "first_name": "JERRY",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "name_suffix": "I",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-07",
        "last_updated": "2014-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NV",
            "license": "05137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparks, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2014; 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.