Active NPI
Mikaela Potrako
- Athletic Trainer
- Auburn, AL
National Provider Identifier
1609386341
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Jul 20, 2023.
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1760
- Practice address
- 560 Devall Dr
Auburn, AL 36832-5813 - Phone
- (334) 844-7616
- Fax
- (334) 844-7616
- NPI assigned
- Oct 9, 2017
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1760 | AL | Primary |
Addresses
Primary practice location
560 Devall Dr
Auburn, AL 36832-5813
Mailing address
425 Opelika Rd Apt 270
Auburn, AL 36830-3926
Phone (484) 639-1882
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1760 | AL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507507200000",
"number": "1609386341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 OPELIKA RD APT 270",
"city": "AUBURN",
"state": "AL",
"postal_code": "368303926",
"telephone_number": "484-639-1882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "560 DEVALL DR",
"city": "AUBURN",
"state": "AL",
"postal_code": "368325813",
"telephone_number": "334-844-7616",
"fax_number": "334-844-7616"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTRAKO",
"first_name": "MIKAELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-09",
"last_updated": "2017-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AL",
"license": "1760",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.