Active NPI
Matthew Ray Potts, PA-C
- Physician Assistant
- Concord, NC
National Provider Identifier
1407839079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 104182
- Practice address
- 354 Copperfield Blvd NE
Concord, NC 28025-2402 - Phone
- (704) 786-5122
- Fax
- (704) 782-8279
- NPI assigned
- Nov 28, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 0001-04182 | NC | |
| Physician Assistant | 363A00000X | 104182 | NC | Primary |
Addresses
Primary practice location
354 Copperfield Blvd NE
Concord, NC 28025-2402
Mailing address
4601 Park Rd
Ste 300
Charlotte, NC 28209-2290
Phone (704) 323-2276
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 215715106A | Medicaid | GA | |
| 215715106B | Medicaid | GA | |
| 215715106D | Medicaid | GA | |
| 215715106C | Medicaid | GA | |
| 215715106E | Medicaid | GA |
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104182 | NC | MD | Physician Assistant |
| 0001-04182 | NC | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479686400000",
"number": "1407839079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 PARK RD",
"address_2": "STE 300",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282092290",
"telephone_number": "704-323-2276",
"fax_number": "704-945-7681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "354 COPPERFIELD BLVD NE",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252402",
"telephone_number": "704-786-5122",
"fax_number": "704-782-8279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTS",
"first_name": "MATTHEW",
"middle_name": "RAY",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-28",
"last_updated": "2016-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NC",
"license": "0001-04182",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "104182",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "215715106A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "215715106B",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "215715106D",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "215715106C",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "215715106E",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.