Garey Potamianos, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019021166 Issued in IL

Practice address

16 E Burlington St
Riverside, IL 60546-2125

Phone

(708) 777-1800

Fax

(708) 777-1801

NPI assigned

Sep 24, 2007

Last updated

Sep 30, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 2, 2021 through Mar 2, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: gpotamianos18696@direct.midwestern.edu

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1639365588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 E BURLINGTON ST",
            "city": "RIVERSIDE",
            "state": "IL",
            "postal_code": "605462125",
            "telephone_number": "708-777-1800",
            "fax_number": "708-777-1801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 E BURLINGTON ST",
            "city": "RIVERSIDE",
            "state": "IL",
            "postal_code": "605462125",
            "telephone_number": "708-777-1800",
            "fax_number": "708-777-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTAMIANOS",
        "first_name": "GAREY",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-24",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019021166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Orthopaedic Associates of Riverside, PLLC
• Colathur K Palani, M.D.
• Paul McArthur Pedersen, LSW
• Alexandria Perry, PT, DPT
• Play Well Therapy Services Inc
• Premier Internal Medicine Group SC
• Themistocles Raftis, PT
• Narges Sedighen Razavizadeh, MD
• RDS - Services LTD
• Karam Rehan, MD

• General Practice Dentistry in Riverside, IL
• Providers in Riverside, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; 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.

Verify at the official NPI Registry.