Jessica M Potvin, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

3807 Issued in AZ

Practice address

222 W Thomas Rd Ste 315
Phoenix, AZ 85013-4422

Phone

(602) 406-3671

Fax

(602) 406-6115

NPI assigned

Oct 4, 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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Sjhmc Physician Services

  dba St. Joseph's Faculty Physicians

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1326098005
  Medicare reassignment Care Compare group NPD
• St Josephs Pathology

  dba Pathology Associates LTD

  • Anatomic Pathology & Clinical Pathology Physician
  • Phoenix, AZ
  • NPI 1265407738
  NPD
• St. Joseph's Hospital and Medical Center

  dba SJHMC Trauma Services

  • Emergency Care Clinic/Center
  • Phoenix, AZ
  • NPI 1255382412
  NPD
• St. Joseph's Outpatient Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Phoenix, AZ
  • NPI 1306843222
  NPD

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1285720771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W THOMAS RD STE 315",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134422",
            "telephone_number": "602-406-3671",
            "fax_number": "602-406-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W THOMAS RD STE 315",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134422",
            "telephone_number": "602-406-3671",
            "fax_number": "602-406-6115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 New Bern Ave",
            "address_2": "Department of Neuropsychology",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276101231",
            "country_code": "US",
            "telephone_number": "919-350-7878",
            "fax_number": "919-350-7130",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "222 W Thomas Rd Ste 401",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "85013",
            "country_code": "US",
            "telephone_number": "602-406-3473",
            "fax_number": "602-406-4406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POTVIN",
        "first_name": "JESSICA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "AZ",
            "license": "3807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Celeste E Pottorff, D.O.
• Donald M Potts, MD
• Jack Potts X, M.D.
• James Potts
• Amanda Potucek, NP
• Mark J Poulin, NP
• Andrew Poulos, MD
• Callie Jordan Poulos, SLPL
• Maria Lyn C Poulson, DC
• Zachary Daniel Poulter

• Clinical Neuropsychologist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Neuropsychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.