NPIMap

Organization Active NPI

Potter Plastic & Reconstructive Surgery, PA

  • Plastic and Reconstructive Surgery Physician
  • Hays, KS
National Provider Identifier
1215314380
Registry record updated Jun 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
05-33528 Issued in KS
Legal business name
POTTER PLASTIC & RECONSTRUCTIVE SURGERY, PA
Practice address
217 E 32ND St
Hays, KS 67601-1698
Phone
(785) 301-2250
Fax
(785) 301-2270
NPI assigned
Apr 28, 2015
Last updated
Jun 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2022

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

Authorized official

Name
Dr. Kirk David Potter, DONPI 1003920877
Title
President
Phone
(785) 639-1668

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X 05-33528 KS
Surgery Physician 208600000X 05-33528 KS
Plastic and Reconstructive Surgery Physician 2086S0122X 05-33528 KS Primary
General Practice Physician 208D00000X 05-33528 KS

Addresses

Primary practice location

217 E 32ND St
Hays, KS 67601-1698

Mailing address

217 E 32ND St
Hays, KS 67601-1698
Phone (785) 301-2250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150804005501 KS Part B Supplier - Clinic/Group Practice 9032423009 Receives reassigned benefits from 3 practitioners
Practice locations: Hays, KS

National Provider Directory

National Provider Directory

Locations

3012 Broadway Ave
Hays, KS 67601
Phone (785) 301-2250

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1430179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654992000000",
    "number": "1215314380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 E 32ND ST",
            "city": "HAYS",
            "state": "KS",
            "postal_code": "676011698",
            "telephone_number": "785-301-2250",
            "fax_number": "785-301-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 E 32ND ST",
            "city": "HAYS",
            "state": "KS",
            "postal_code": "676011698",
            "telephone_number": "785-301-2250",
            "fax_number": "785-301-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTTER PLASTIC & RECONSTRUCTIVE SURGERY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-28",
        "last_updated": "2022-06-12",
        "certification_date": "2022-06-12",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "785-639-1668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "KS",
            "license": "05-33528",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KS",
            "license": "05-33528",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "KS",
            "license": "05-33528",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "KS",
            "license": "05-33528",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hays, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.