Thena Gidget Poteat, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

03611132 Issued in IL

Practice address

6805 State Route 162 Ste 201
Maryville, IL 62062-8530

Phone

(618) 288-5189

NPI assigned

Jun 1, 2006

Sex

Female

Sole proprietor

No

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 IL

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

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17590/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir4.healow.com/fhir/r4/AFHDDD

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.

• Southern Illinois Associates LLC

  • Psychiatry Physician
  • Maryville, IL
  • NPI 1962427856
  Medicare reassignment NPD
• Psychiatric Urgent Care LLC

  • Urgent Care Clinic/Center
  • Maryville, IL
  • NPI 1134843451
  NPD
• Franklin Medical Group, PC

  • Internal Medicine Physician
  • Waterbury, CT
  • NPI 1780686964

  Psychiatry

  NPD (past)

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1114964566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6805 IL 162",
            "address_2": "SUITE 201",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620624181",
            "telephone_number": "618-288-5189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6805 STATE ROUTE 162 STE 201",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628530",
            "telephone_number": "618-288-5189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTEAT",
        "first_name": "THENA",
        "middle_name": "GIDGET",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "03611132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036111132",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Petru, CRNA
• Mackenzie R Pherigo, LCSW, CADC
• Danuta J Pikul, MD
• Marcus A. Piper, M.S., L.C.P.C.
• Samantha Jean Pisarski, PA-C
• James S Powell, MD
• Premier Foot and Ankle of Illinois, PC
• Progressive Health Care for Women, LTD
• Psychiatric Urgent Care LLC
• Ashlee K Pugh, COTA/L

• Psychiatry Physician in Maryville, IL
• Providers in Maryville, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.