Active NPI
Karen Suzanne Potter, DDS
- Endodontics
- San Clemente, CA
National Provider Identifier
1548459944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 56202
- Practice address
- 665 Camino de Los Mares
Suite 204
San Clemente, CA 92673-2859 - Phone
- (949) 661-9680
- NPI assigned
- Oct 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 56202 | CA | Primary |
Addresses
Primary practice location
665 Camino de Los Mares
Suite 204
San Clemente, CA 92673-2859
Mailing address
665 Camino de Los Mares
Suite 204
San Clemente, CA 92673-2859
Phone (949) 661-9680
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 16, 2018 through Apr 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56202 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285027200000",
"number": "1548459944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "665 CAMINO DE LOS MARES",
"address_2": "SUITE 204",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "926732859",
"telephone_number": "949-661-9680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "665 CAMINO DE LOS MARES",
"address_2": "SUITE 204",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "926732859",
"telephone_number": "949-661-9680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTER",
"first_name": "KAREN",
"middle_name": "SUZANNE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-22",
"last_updated": "2010-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "56202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Clemente, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.