Sergey Sergeyevich Potepalov, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

P9695 Issued in TX

Practice address

500 W Medical Center Blvd
Department of Emergency Medicine
Webster, TX 77598-4220

Phone

(281) 338-3708

Fax

(281) 338-3224

NPI assigned

May 10, 2010

Last updated

Oct 29, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Emergency Medicine

Education

Louisiana State University School of Medicine in Shreveport, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrative Emergency Services Physician Group-Houston PLLCGroup PAC ID 7113258500, 212 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI St Luke's Health Brazosport Hospital, Lake Jackson, TX, CCN 450072
• Sweeny Community Hospital Hospital, Sweeny, TX, CCN 451311

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Integrative Emergency Services Physician Group-Houston PLLC

  dba IES Houston

  • Emergency Medicine Physician
  • Pasadena, TX
  • NPI 1801458708
  Medicare reassignment Care Compare group NPD
• Acs Primary Care Physicians Southwest, PA

  • Emergency Medicine Physician
  • Gainesville, TX
  • NPI 1538101019
  Medicare reassignment NPD
• Sound Physicians Emergency Medicine of Texas PLLC

  • Emergency Medicine Physician
  • Killeen, TX
  • NPI 1518475557
  Medicare reassignment NPD
• Concord Medical Group of Texas PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1750790762
  Medicare reassignment
• Concord Medical Group PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1083630610
  Medicare reassignment
• Methodist Health Centers

  dba Houston Methodist Cypress Hospital

  • General Acute Care Hospital
  • Cypress, TX
  • NPI 1629828405
  NPD (past)
• Singleton Associates PA

  • Diagnostic Radiology Physician
  • Shenandoah, TX
  • NPI 1538107875
  NPD (past)
• St. Luke's Community Health Services

  • Rehabilitation Hospital Unit
  • The Woodlands, TX
  • NPI 1255785382
  NPD (past)

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

• Sweeny Hospital District

  dba Sweeny Community Hospital

  • Critical Access Hospital
  • Sweeny, TX
  • NPI 1023011657
  Care Compare affiliation
• The Community Hospital of Brazosport

  dba Brazosport Memorial Hospital &Brazosport Regional Health System

  • General Acute Care Hospital
  • Lake Jackson, TX
  • NPI 1972581940
  Care Compare affiliation

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

{
    "created_epoch": "1273449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446076800000",
    "number": "1215255633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W MEDICAL CENTER BLVD",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775984220",
            "telephone_number": "281-338-3708",
            "fax_number": "281-338-3224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W MEDICAL CENTER BLVD",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775984220",
            "telephone_number": "281-338-3708",
            "fax_number": "281-338-3224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTEPALOV",
        "first_name": "SERGEY",
        "middle_name": "SERGEYEVICH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-10",
        "last_updated": "2015-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "MD.20529",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "P9695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "337030602",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2103610",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Polaris Anesthesia PLLC
• Kristen Mary Polaski, PT, DPT
• Sudheera Polavarapu, M.B.B.S
• Lorrie Faith Pool, APRN
• Julie Raeline Porter
• Hussein Munaver Pothiwalla, MD
• Theresa A. Powers, OTR
• Pranav H Bhakta MD PA
• Naushin Prasla, PA-C
• Precision Medical Group, PLLC

• Emergency Medicine Physician in Webster, TX
• Providers in Webster, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; 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.