Individual provider Active NPI

Michael L. Potter, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Medford, OR
National Provider Identifier
1457388191
Registry record updated Nov 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
MD23161 Issued in OR
Practice address
70 Bower Dr Ste 240
Medford, OR 97501-3689
Phone
(541) 732-8790
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X MD23161 OR Primary
Family Medicine Physician 207Q00000X MD23161 OR

Addresses

Primary practice location

70 Bower Dr Ste 240
Medford, OR 97501-3689

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Other identifiers 1

IdentifierTypeStateIssuer
228818MedicaidOR

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mpotter855467@oc.providencedirect.org
Direct Messaging Address mpotter855467@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20040707001469 OR Practitioner - Sports MedicinePractitioner - Family Practice 7618955642 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice
Education
Oregon Health Sciences University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

870 S Front St
Suite 200
Central Point, OR 97502-2779
Phone (541) 664-3346

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD23161ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services Oregon Family Medicine Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Nov 1, 2017 Accepting new patients
Providence Health & Services - Oregon Family Medicine CurrentSince Nov 1, 2017 Accepting new patients
Providence Health & Services - Oregon CurrentSince Nov 1, 2017 Accepting new patients
Firstcare Medical Foundation Family Medicine Past Accepting new patients

Locations

940 Royal Ave
Unit 350
Medford, OR 97504
Phone (541) 732-7460

965 Ellendale Dr
Medford, OR 97504
Phone (541) 732-6000

70 Bower Dr
Ste 240
Medford, OR 97501
Phone (541) 732-8360

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

870 S Front St
Ste 200
Medford, OR 97502
Phone (541) 664-3346

Interoperability endpoints

  • Direct secure messaging: mpotter855467@oc.providencedirect.org

Organizations & group practices 6

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 2

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": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1457388191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 BOWER DR STE 240",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975013689",
            "telephone_number": "541-732-8790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "MICHAEL",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "OR",
            "license": "MD23161",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD23161",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "228818",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpotter855467@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "70 Bower Dr Ste 240",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975013689",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpotter855467@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "70 S FRONT ST",
            "address_2": "suite 200",
            "city": "central point",
            "state": "OR",
            "country_code": "US",
            "postal_code": "97502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.