Active NPI
Douglas Allyn Pote, MD
- Family Medicine Physician
- Glade Spring, VA
National Provider Identifier
1194722652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0101034124
- Practice address
- 636 S Monte Vista Dr
Glade Spring, VA 24340-2712 - Phone
- (276) 429-5163
- Fax
- (276) 429-5515
- NPI assigned
- Jun 30, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101034124 | VA | Primary |
Addresses
Primary practice location
636 S Monte Vista Dr
Glade Spring, VA 24340-2712
Mailing address
636 S Monte Vista Dr
Glade Spring, VA 24340-2712
Phone (276) 429-5163
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01372202 | Other | VA | RR MEDICARE |
| 610722601 | Other | VA | DEPT OF LABOR |
| 007610131 | Medicaid | VA | |
| 240748 | Other | VA | ANTHEM |
| 1194722652 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101034124 | VA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487721600000",
"number": "1194722652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "636 S MONTE VISTA DR",
"city": "GLADE SPRING",
"state": "VA",
"postal_code": "243402712",
"telephone_number": "276-429-5163",
"fax_number": "276-429-5515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "636 S MONTE VISTA DR",
"city": "GLADE SPRING",
"state": "VA",
"postal_code": "243402712",
"telephone_number": "276-429-5163",
"fax_number": "276-429-5515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTE",
"first_name": "DOUGLAS",
"middle_name": "ALLYN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-30",
"last_updated": "2017-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "0101034124",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P01372202",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR",
"identifier": "610722601",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007610131",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "240748",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1194722652",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glade Spring, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.