Individual provider Active NPI

Tony Joseph Potter, D.C.

  • Chiropractor
  • Elk Grove, CA
National Provider Identifier
1356451637
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
21781 Issued in CA
Practice address
9632 Emerald Oak Dr
Suite B
Elk Grove, CA 95624-2258
Phone
(916) 685-1234
Fax
(916) 685-6214
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 21781 CA Primary

Addresses

Primary practice location

9632 Emerald Oak Dr
Suite B
Elk Grove, CA 95624-2258

Mailing address

9632 Emerald Oak Dr
Suite B
Elk Grove, CA 95624-2258
Phone (916) 685-1234

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090902000335 CA Practitioner - Chiropractic 1052463650 Practice locations: Elk Grove, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Master of Arts

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356451637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9632 EMERALD OAK DR",
            "address_2": "SUITE B",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "956242258",
            "telephone_number": "916-685-1234",
            "fax_number": "916-685-6214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9632 EMERALD OAK DR",
            "address_2": "SUITE B",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "956242258",
            "telephone_number": "916-685-1234",
            "fax_number": "916-685-6214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "TONY",
        "middle_name": "JOSEPH",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "21781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.