Individual provider Active NPI

Benjamin Potter, DPM

  • Foot & Ankle Surgery Podiatrist
  • Kingsport, TN
National Provider Identifier
1063919793
Registry record updated Feb 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
905 Issued in TN
Practice address
430 W Ravine Rd
Kingsport, TN 37660-3868
Phone
(423) 245-3161
Fax
(423) 245-8916
NPI assigned
Apr 9, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 905 TN Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 135.001005 IL
Foot Surgery Podiatrist 213ES0131X 905 TN

Addresses

Primary practice location

430 W Ravine Rd
Kingsport, TN 37660-3868

Mailing address

1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 952-2111

Other practice location 1

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 224-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220208002418 TN Practitioner - Podiatry 5991196719 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmont Medical Associates IncGroup PAC ID 8123291739, 432 clinicians
Associated Orthopaedics of Kingsport PCGroup PAC ID 4789846700, 12 clinicians

Practice addresses (Care Compare)

111 W Stone Dr
Kingsport, TN 37660-6027

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 230-8200

430 W Ravine Rd
Kingsport, TN 37660-3868
Phone (423) 245-3161

Hospital & facility affiliations

  • Wellmont Holston Valley Medical Center Hospital, Kingsport, TN, CCN 440017

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue29
Removal of nail tissue15
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
135.001005ILMDFoot & Ankle Surgery Podiatrist
905TNMDFoot Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmont Medical Associates, Inc. CurrentSince Aug 1, 2025 Accepting new patients
Wellmont Medical Associates Inc CurrentSince Aug 1, 2025 Accepting new patients
Wellmont Health System Current Accepting new patients
Associated Orthopaedics of Kingsport PC CurrentSince Jan 10, 2022 Accepting new patients
Associated Orthopaedics of Kingsport PC Current Accepting new patients
Associated Orthopaedics of Kingsport PC Past Accepting new patients
Blue Ridge Medical Management Corporation Past Accepting new patients

Locations

1 Medical Park Blvd
Ste 300E
Bristol, TN 37620
Phone (423) 245-3161

1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

430 W Ravine Rd
Kingsport, TN 37660
Phone (423) 245-3161

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

Interoperability endpoints

  • Direct secure messaging: bpotter283067@balladhealth.medalliesdirect.net
  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1579

Organizations & group practices 7

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771545600000",
    "number": "1063919793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-952-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 W RAVINE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603868",
            "telephone_number": "423-245-3161",
            "fax_number": "423-245-8916"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 W Ravine Rd",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376603837",
            "country_code": "US",
            "telephone_number": "423-224-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POTTER",
        "first_name": "BENJAMIN",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-09",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "TN",
            "license": "905",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "135.001005",
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "TN",
            "license": "905",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.