Active NPI
Stephen Dean Potts, PHARMD
- Pharmacist
- Fairfield, IL
National Provider Identifier
1407485915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051302007
- Practice address
- 709 W Main St Ste a
Fairfield, IL 62837-2312 - Phone
- (618) 919-4009
- Fax
- (618) 516-8988
- NPI assigned
- Apr 6, 2020
- Last updated
- May 18, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051302007 | IL | Primary |
Addresses
Primary practice location
709 W Main St Ste a
Fairfield, IL 62837-2312
Mailing address
709 W Main St Ste a
Fairfield, IL 62837-2312
Phone (618) 919-4009
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 810998287001 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051302007 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Potts Family LLC | Current | Accepting new patients |
Locations
709 W Main St
Ste A
Fairfield, IL 62837
Phone (618) 919-4009
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652832000000",
"number": "1407485915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 W MAIN ST STE A",
"city": "FAIRFIELD",
"state": "IL",
"postal_code": "628372312",
"telephone_number": "618-919-4009",
"fax_number": "618-516-8988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 W MAIN ST STE A",
"city": "FAIRFIELD",
"state": "IL",
"postal_code": "628372312",
"telephone_number": "618-919-4009",
"fax_number": "618-516-8988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTS",
"first_name": "STEPHEN",
"middle_name": "DEAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-06",
"last_updated": "2022-05-18",
"certification_date": "2022-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051302007",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "810998287001",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.