Jerry Lynn Potts, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

C4520 Issued in AR

Practice address

1408 W 43Rd Ave
Pine Bluff, AR 71603-7010

Phone

(870) 535-5719

Fax

(870) 536-1963

NPI assigned

Feb 28, 2006

Last updated

Aug 21, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Arkansas Otolaryngology Center, P.a.

  dba Aoc Surgery Center, Inc

  • Ambulatory Surgical Clinic/Center
  • Little Rock, AR
  • NPI 1093795031
  NPD (past)
• Arkansas Otolaryngology Center, P.a.

  • Otolaryngology Physician
  • Little Rock, AR
  • NPI 1164449500
  NPD (past)

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219276800000",
    "number": "1447226477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 W 43RD AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037010",
            "telephone_number": "870-535-5719",
            "fax_number": "870-536-1963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 W 43RD AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037010",
            "telephone_number": "870-535-5719",
            "fax_number": "870-536-1963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTS",
        "first_name": "JERRY",
        "middle_name": "LYNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2008-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "AR",
            "license": "C4520",
            "primary": false
        },
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "AR",
            "license": "C4520",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "AR",
            "license": "C4520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS BLUE CROSS BLUE SHIELD",
            "identifier": "54134",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104787001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pine Ridge Healthcare, LLC
• James Alan Pollard, MD
• Barbara J Porter
• Positive Place Counseling and Consulting, LLC
• Ashwini Potharam
• Rebecca L Powell, RD, LD
• Lisa Prescott
• Crystal Pridgeon
• Nekita Pridgeon
• Prime Medical Group PLLC

• Otolaryngology Physician in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Otolaryngology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.