Lynn A Wanderer-Potter, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7762 Issued in AZ

Practice address

6739 W Cactus Rd
Peoria, AZ 85381-5311

Phone

(202) 455-0013

Fax

(623) 889-0814

NPI assigned

Aug 30, 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

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1970

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Active Vital Care LLCGroup PAC ID 3870942428, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Active Vital Care LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1326825092
  Medicare reassignment Care Compare group
• Angels Valley Community Healthcare Center PLLC

  • Physician Assistant
  • Phoenix, AZ
  • NPI 1689303117
  Medicare reassignment

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1174633994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10521 E SPRING CREEK RD",
            "city": "SUN LAKES",
            "state": "AZ",
            "postal_code": "852488824",
            "telephone_number": "505-350-5766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6739 W CACTUS RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815311",
            "telephone_number": "202-455-0013",
            "fax_number": "623-889-0814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANDERER-POTTER",
        "first_name": "LYNN",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walmart Inc.
• Laura Ingram Walpole, DO
• Elisabeth Walsh, PTA
• Carli Nicole Walter, PA-C
• Jarvis Wayne Walters, DO
• Li Wang
• Ping Y Wang, MD
• Wei Wang, FNP-C
• Christy Marie Ward
• Richard Eugene Warner, DDS

• Physician Assistant in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.