Orie R Potter, PAC MPAS

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085000614 Issued in IL

Practice address

1400 E Carroll
Macomb, IL 61455

Phone

(309) 833-2500

Fax

(309) 833-1760

NPI assigned

Apr 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL, IA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: opotter1216511@direct.unitypoint.org
• Direct secure messaging: opotterpa421497@carlehiedirect.net
• Direct secure messaging: opotter3935570@direct.trinity-health.org

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.

• Carle Health Care Incorporated

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947

  IL

  Medicare reassignment NPD
• Genesis Health System

  • General Acute Care Hospital
  • Silvis, IL
  • NPI 1427132604

  IL

  Medicare reassignment NPD
• Trinity Medical Center

  • Emergency Medicine Physician
  • Rock Island, IL
  • NPI 1568414134

  IL, Physician Assistant

  Medicare reassignment NPD
• Southeast Iowa Regional Medical Center, Inc.

  • General Practice Physician
  • West Burlington, IA
  • NPI 1164433884

  IA

  Medicare reassignment NPD
• McDonough County Hospital District

  • Internal Medicine Physician
  • Macomb, IL
  • NPI 1609180082

  IL

  Medicare reassignment
• Methodist Medical Center of Illinois

  • Emergency Care Clinic/Center
  • Peoria, IL
  • NPI 1265966048

  IL

  Medicare reassignment
• Methodist Medical Center of Illinois

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1982656575

  IL

  Medicare reassignment
• Trinity Medical Center

  • Psychiatry Physician
  • Rock Island, IL
  • NPI 1033163829

  IA

  Medicare reassignment
• Iowa Emergency Physicians LLP

  • Emergency Medicine Physician
  • Waterloo, IA
  • NPI 1386879427

  IA

  Medicare reassignment
• Iowa Emergency Services LLC

  • Emergency Medicine Physician
  • Clinton, IA
  • NPI 1821591454

  IA

  Medicare reassignment
• Unity Healthcare

  • Internal Medicine Physician
  • Muscatine, IA
  • NPI 1629122742

  IA

  Medicare reassignment
• McDonough County Hospital District

  • Anatomic Pathology & Clinical Pathology Physician
  • Macomb, IL
  • NPI 1396055869
  NPD

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

{
    "created_epoch": "1143849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1477514958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198",
            "city": "OQUAWKA",
            "state": "IL",
            "postal_code": "614690198",
            "telephone_number": "309-867-2202",
            "fax_number": "309-867-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E CARROLL",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "61455",
            "telephone_number": "309-833-2500",
            "fax_number": "309-833-1760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "ORIE",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PAC MPAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-01",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001876",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085000614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371352599001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Petersen Health Operations, LLC
• Petersen Health Properties, LLC
• Jennifer M Plos, ATC
• Kathryn Ann Pohlpeter
• Renee L Polubinsky, ATC, CSCS
• Melissa L Pounders, NP-C
• Brenda Powell-Allen, CWNP
• Jodi Powell, ANP
• John Robert Prain, CADC
• Robert William Price III, DMD

• All providers in Macomb, IL
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; 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.