Individual provider Active NPI

Andrew William Potter, M.D.

  • Diagnostic Radiology Physician
  • Fort Wayne, IN
National Provider Identifier
1386811263
Registry record updated Oct 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01069990A Issued in IN
Practice address
3707 New Vision Dr
Fort Wayne, IN 46845-1702
Phone
(260) 471-9466
NPI assigned
May 10, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X M9583 TX
Diagnostic Radiology Physician 2085R0202X 01069990A IN Primary
Diagnostic Radiology Physician 2085R0202X 35.097940 OH

Addresses

Primary practice location

3707 New Vision Dr
Fort Wayne, IN 46845-1702

Mailing address

116 Eagle Cliff CV
Huntertown, IN 46748-9288
Phone (281) 753-6095

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110803000369 IN Practitioner - Diagnostic Radiology 3870787377 Reassigns benefits to 2 organizations
I20120515000325 OH Practitioner - Diagnostic Radiology 3870787377 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Indiana University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fort Wayne Radiology Associates LLCGroup PAC ID 5294624060, 35 clinicians
Community Hospitals and Wellness CentersGroup PAC ID 7517878093, 4 clinicians

Practice addresses (Care Compare)

1035 W Wayne St
Paulding, OH 45879-1544
Phone (419) 399-4080

11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701
Phone (260) 266-1000

11141 Parkview Plaza Dr
Suite 100
Fort Wayne, IN 46845-1714
Phone (260) 266-9030

116 Eagle Cliff CV
Huntertown, IN 46748-9288
Phone (260) 471-9466

3707 New Vision Dr
Fort Wayne, IN 46845-1702
Phone (260) 969-1124

433 W High St
Bryan, OH 43506-1690
Phone (419) 636-1131

Hospital & facility affiliations

  • Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
  • Parkview Whitley Hospital Hospital, Columbia City, IN, CCN 150101
  • Community Hospitals and Wellness Centers Hospital, Bryan, OH, CCN 360121
  • Parkview Huntington Hospital Hospital, Huntington, IN, CCN 150091
  • Parkview Noble Hospital Hospital, Kendallville, IN, CCN 150146

Merit-based Incentive Payment System (MIPS)

Final score
80.28 of 100Reported as group
Quality
77.29
Improvement activities
40
Cost
73.88

Merit-based Incentive Payment System (MIPS)

Final score
85.81 of 100Reported as group
Quality
80.59
Promoting interoperability
100
Improvement activities
40
Cost
72.11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01069990AINMDDiagnostic Radiology Physician
35.097940OHMDDiagnostic Radiology Physician
M9583TXMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
P.E.T. Imaging Services, LLC Diagnostic Radiology CurrentSince Dec 15, 2011 Accepting new patients
Fort Wayne Radiology Associates LLC Diagnostic Radiology CurrentSince Jul 1, 2011 Accepting new patients
Community Hospitals and Wellness Centers CurrentSince Mar 16, 2021 Accepting new patients
Community Hospitals and Wellness Centers CurrentSince Mar 16, 2021 Accepting new patients

Locations

3707 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 373-4000

10202 Coldwater Rd
Ste A
Fort Wayne, IN 46825
Phone (260) 469-2525

1355 Mariners Dr
Warsaw, IN 46582
Phone (574) 267-6778

121 Westfield Dr
Archbold, OH 43502
Phone (419) 445-2015

433 W High St
Bryan, OH 43506
Phone (419) 636-1131

909 E Snyder Ave
Montpelier, OH 43543
Phone (419) 485-3154

1035 W Wayne St
Paulding, OH 45879
Phone (419) 399-4080

Interoperability endpoints

  • Direct secure messaging: apotter5@direct.iuhealth.org
  • Direct secure messaging: apotter2@yourcarecommunity.org

Organizations & group practices 4

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.

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": "1210377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318377600000",
    "number": "1386811263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 EAGLE CLIFF CV",
            "city": "HUNTERTOWN",
            "state": "IN",
            "postal_code": "467489288",
            "telephone_number": "281-753-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3707 NEW VISION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451702",
            "telephone_number": "260-471-9466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "ANDREW",
        "middle_name": "WILLIAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-10",
        "last_updated": "2011-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "M9583",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01069990A",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35.097940",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.