NPIMap

Individual provider Active NPI

Egor Potekin, M.D.

  • Internal Medicine Physician
  • Springfield, MO
National Provider Identifier
1336602713
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2022026390 Issued in MO
Practice address
1001 E Primrose St FL 4
Springfield, MO 65807-5155
Phone
(417) 875-3000
NPI assigned
Apr 11, 2019
Last updated
Sep 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 2022026390 MO Primary

Addresses

Primary practice location

1001 E Primrose St FL 4
Springfield, MO 65807-5155

Mailing address

PO Box 802843
Kansas City, MO 64180-2843

Other practice location 1

24 Hospital Avenue, Kathleen Barry
Danbury, CT 06810-6099
Phone (203) 739-8105

Other identifiers 1

IdentifierTypeStateIssuer
200111888MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220726000815 MO Practitioner - Internal Medicine 8123359957 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lester E Cox Medical CentersGroup PAC ID 8628092897, 243 clinicians

Practice addresses (Care Compare)

1001 E Primrose
Springfield, MO 65807-5155

1001 E Primrose St
Springfield, MO 65807-5155

13852 US Hwy 160
Forsyth, MO 65653-5156
Phone (417) 546-3500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.41 of 100Reported as group
Quality
76.32
Promoting interoperability
100
Improvement activities
40
Cost
81.7

Merit-based Incentive Payment System (MIPS)

Final score
82.25 of 100Reported as group
Quality
64.73
Promoting interoperability
100
Improvement activities
40
Cost
76.1

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Skaggs Community Hospital Association CurrentSince Dec 25, 2023 Accepting new patients
Skaggs Community Hospital Association CurrentSince Dec 25, 2023 Accepting new patients
Lester E Cox Medical Centers CurrentSince Aug 8, 2022 Accepting new patients
Skaggs Community Hospital Association Current Accepting new patients
Ozarks Medical Center Past Accepting new patients
Lester E Cox Medical Centers Past Accepting new patients

Locations

1001 E Primrose St
Springfield, MO 65807
Phone (417) 875-3434

1001 E Primrose St
Fl 4
Springfield, MO 65807

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1336602713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 802843",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641802843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 E PRIMROSE ST FL 4",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075155",
            "telephone_number": "417-875-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Hospital Avenue, Kathleen Barry",
            "address_purpose": "LOCATION",
            "city": "Danbury",
            "state": "CT",
            "postal_code": "068106099",
            "country_code": "US",
            "telephone_number": "203-739-8105",
            "fax_number": "203-749-9092",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POTEKIN",
        "first_name": "EGOR",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-11",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2022026390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200111888",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.