NPIMap

Individual provider Active NPI

McKenna Ray Campbell-Potter

  • Sports Medicine (Internal Medicine) Physician
  • New York, NY
National Provider Identifier
1164041562
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X
License
328701 Issued in NY
Practice address
535 E 70TH St
New York, NY 10021-4823
Phone
(212) 606-1791
NPI assigned
Apr 15, 2020
Last updated
Aug 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Internal Medicine) Physician 207RS0010X 328701 NY Primary

Addresses

Primary practice location

535 E 70TH St
New York, NY 10021-4823

Mailing address

535 E 70TH St
New York, NY 10021-4823

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250818001705 NY Practitioner - Sports Medicine 3971926346 Reassigns benefits to 1 organization
I20251003001480 NJ Practitioner - Sports Medicine 3971926346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports Medicine
Education
University of Minnesota Medical School, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ny Society for the Relief of Ruptured and Crippled MaintainingGroup PAC ID 4082856513, shared by 2 NPIs, 175 clinicians

Practice addresses (Care Compare)

15 E Midland Ave
Paramus, NJ 07652-2938
Phone (201) 599-8000

541 E 71St St
New York, NY 10021-4871
Phone (646) 797-8973

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
328701NYMDSports Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ny Society for the Relief of Ruptured & Crippled Maintaining CurrentSince Sep 1, 2025 Accepting new patients
Ny Society for the Relief of Ruptured & Crippled Maintaining CurrentSince Sep 1, 2025 Accepting new patients

Locations

140 E Ridgewood Ave
#175S
Paramus, NJ 07652

15 E Midland Ave
Paramus, NJ 07652
Phone (201) 267-7200

15 E Midland Ave
Ste 1A
Paramus, NJ 07652
Phone (201) 599-8000

535 E 70th St
New York, NY 10021

541 E 71st St
New York, NY 10021
Phone (212) 606-1136

Interoperability endpoints

  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: mcampbellpotter329388@direct.hss.edu

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.

Hospital & facility affiliations 10

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": "1586908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1164041562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 E 70TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 E 70TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214823",
            "telephone_number": "212-606-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL-POTTER",
        "first_name": "MCKENNA",
        "middle_name": "RAY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-15",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "NY",
            "license": "328701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.