NPIMap

Individual provider Active NPI

John H Potomski Jr., DO CMA

  • Geriatric Medicine (Internal Medicine) Physician
  • Melbourne, FL
National Provider Identifier
1083657183
Registry record updated Oct 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
OS4425 Issued in FL
Practice address
720 E New Haven Ave
Melbourne, FL 32901
Phone
(321) 724-4545
Fax
(321) 728-4168
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X OS4425 FL Primary

Addresses

Primary practice location

720 E New Haven Ave
Melbourne, FL 32901

Mailing address

720 E New Haven Ave Ste 11
Melbourne, FL 32901-5474
Phone (321) 724-4545

Other identifiers 1

IdentifierTypeStateIssuer
067596200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100806000228 FL Practitioner - Geriatric Medicine 7416080759 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Philadelphia College of Osteopathic Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ballout International PLLCGroup PAC ID 5890045256, 48 clinicians
Florida Rehab Specialists, PLLCGroup PAC ID 5890155279, 82 clinicians

Practice addresses (Care Compare)

1310 37TH St
Vero Beach, FL 32960-4860
Phone (321) 387-9451

817 NW 56TH Ter
Suite B
Gainesville, FL 32605-6401
Phone (352) 234-3050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Medical Assistant, Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS4425FLMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brevard Geriatrics, LLC CurrentSince May 14, 2014 Accepting new patients
Florida Rehab Specialists, PLLC Geriatric Medicine CurrentSince Jan 27, 2026 Accepting new patients
Physicians of South Florida, LLC PastSince Mar 1, 2012 Accepting new patients
Osler Hma Medical Group LLC Geriatric Medicine Past Accepting new patients
Osler Medical Inc Past Accepting new patients

Locations

817 NW 56th Ter
Ste B
Gainesville, FL 32605
Phone (352) 331-7771

720 E New Haven Ave
Ste 11
Melbourne, FL 32901
Phone (254) 236-5079

720 E New Haven Ave
Melbourne, FL 32901
Phone (321) 724-4545

1515 Port Malabar Blvd NE
Ste 11
Palm Bay, FL 32905
Phone (321) 723-1255

8050 Spyglass Rd
Viera, FL 32940
Phone (321) 752-1000

7999 Spyglass Hill Rd
Viera, FL 32940
Phone (321) 242-1006

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2982/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570147200000",
    "number": "1083657183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 E NEW HAVEN AVE STE 11",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015474",
            "telephone_number": "321-724-4545",
            "fax_number": "321-728-4168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 E NEW HAVEN AVE",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32901",
            "telephone_number": "321-724-4545",
            "fax_number": "321-728-4168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTOMSKI",
        "first_name": "JOHN",
        "middle_name": "H",
        "name_suffix": "Jr.",
        "credential": "DO CMA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2019-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "OS4425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067596200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.