Dennis Potabenko, H.I.S

Primary specialty

Hearing Instrument SpecialistTaxonomy code 237700000X

License

2778 Issued in MN

Practice address

5640 W Broadway Ave Ste B
Crystal, MN 55428-3567

Phone

(763) 533-5722

Fax

(763) 533-5654

NPI assigned

Apr 6, 2016

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Miracle Ear, Inc

  • Hearing Instrument Specialist
  • Burnsville, MN
  • NPI 1609001874
  NPD (past)

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

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459900800000",
    "number": "1356705396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5640 W BROADWAY AVE STE B",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554283567",
            "telephone_number": "763-533-5722",
            "fax_number": "763-533-5654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5640 W BROADWAY AVE STE B",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554283567",
            "telephone_number": "763-533-5722",
            "fax_number": "763-533-5654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTABENKO",
        "first_name": "DENNIS",
        "credential": "H.I.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-06",
        "last_updated": "2016-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "MN",
            "license": "2778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charet Jean Pelkey, LPT
• Corinna Peterson
• Jan Marie Peterson, PHARMD
• Kimberly Ann Plessel, MS, RD, LD
• Andrew Karn Pogreba
• Rachel A Potter, LICSW
• Progressive Home Health, LLC
• Samira F Qazi, OD
• Quality Health Care Services
• Ayesha Alam Qureshi

• Hearing Instrument Specialist in Crystal, MN
• Providers in Crystal, MN by specialty
• Hearing Instrument Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.