Individual provider Active NPI

David Thomas Potter, MD

  • Psychiatry Physician
  • Spokane, WA
National Provider Identifier
1396759197
Registry record updated May 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD00046532 Issued in WA
Practice address
107 S Division St
Spokane, WA 99202
Phone
(509) 838-4651
Fax
(509) 363-2762
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X D0060488 MD
Pain Medicine (Psychiatry & Neurology) Physician 2084P2900X MD00046532 WA
Psychiatry Physician 2084P0800X MD00046532 WA Primary

Addresses

Primary practice location

107 S Division St
Spokane, WA 99202

Mailing address

107 S Division St
Spokane, WA 99202-1510
Phone (509) 838-4651

Other identifiers 2

IdentifierTypeStateIssuer
402429000MedicaidMD
1396759197MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20070822001159 WA Practitioner - Psychiatry 8022109891 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Maryland School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Frontier Behavioral HealthGroup PAC ID 5092603340, 39 clinicians

Practice addresses (Care Compare)

107 S Division St
Spokane, WA 99202-1510
Phone (509) 838-4651

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. 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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0060488MDMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Frontier Behavioral Health Psychiatry CurrentSince Oct 2, 2015 Accepting new patients
University of Maryland Psychiatry Associates, PA Psychiatry Past Accepting new patients

Locations

107 S Division St
Spokane, WA 99202
Phone (509) 383-4651

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526428800000",
    "number": "1396759197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 S DIVISION ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021510",
            "telephone_number": "509-838-4651",
            "fax_number": "509-363-2762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 S DIVISION ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "99202",
            "telephone_number": "509-838-4651",
            "fax_number": "509-363-2762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "DAVID",
        "middle_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2018-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D0060488",
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "WA",
            "license": "MD00046532",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00046532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402429000",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396759197",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.