Individual provider Active NPI

John Algas Potenciano, DNP

  • Adult Health Nurse Practitioner
  • Albany, NY
National Provider Identifier
1326313479
Registry record updated Sep 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
306009 Issued in NY
Practice address
747 Madison Ave Ste 201
Albany, NY 12208-3809
Phone
(518) 364-0648
Fax
(518) 438-0282
NPI assigned
Mar 21, 2012
Last updated
Sep 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 306009 NY Primary

Addresses

Primary practice location

747 Madison Ave Ste 201
Albany, NY 12208-3809

Mailing address

747 Madison Ave Ste 201
Albany, NY 12208-3809
Phone (518) 364-0648

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20130128000294 NY Practitioner - Nurse Practitioner 5496909475 Practice locations: Albany, NY

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

747 Madison Ave
Suite 302
Albany, NY 12208-3809
Phone (518) 463-1855

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693785600000",
    "number": "1326313479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 MADISON AVE STE 201",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083809",
            "telephone_number": "518-364-0648",
            "fax_number": "518-438-0282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 MADISON AVE STE 201",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083809",
            "telephone_number": "518-364-0648",
            "fax_number": "518-438-0282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTENCIANO",
        "first_name": "JOHN",
        "middle_name": "ALGAS",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-21",
        "last_updated": "2023-09-04",
        "certification_date": "2023-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "306009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.