NPIMap

Individual provider Active NPI

Douglas J Potoczak, MD

  • Family Medicine Physician
  • N Ridgeville, OH
National Provider Identifier
1710190046
Registry record updated Dec 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35060432 Issued in OH
Practice address
6115 Emerald St
N Ridgeville, OH 44039-2047
Phone
(440) 406-5800
Fax
(216) 201-6914
NPI assigned
May 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35060432 OH Primary

Addresses

Primary practice location

6115 Emerald St
N Ridgeville, OH 44039-2047

Mailing address

PO Box 636643
Cincinnati, OH 45263-6643
Phone (440) 989-3801

Other identifiers 2

IdentifierTypeStateIssuer
3025372MedicaidOH
0897874MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address douglaspotoczak@uhps.allscripts.net
Direct Messaging Address douglaspotoczak@uhps.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100525000688 OH Practitioner - Family Practice 7517003841 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wright State University Boonshoft School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11100 Euclid Ave
Cleveland, OH 44106-1716

158 W Main Rd
Conneaut, OH 44030-2039

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35060432OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Primary Care Practices Inc Family Medicine CurrentSince Feb 3, 2019 Accepting new patients
University Primary Care Practices Inc Current Accepting new patients
University Primary Care Practices Inc CurrentSince Feb 3, 2019 Accepting new patients
University Hospitals Medical Group Inc Past Accepting new patients
University Primary Care Practices Past Accepting new patients

Locations

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

Interoperability endpoints

  • Direct secure messaging: dpotoczak21068@ehrdirect.uhhospitals.org

Organizations & group practices 5

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 7

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": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608163200000",
    "number": "1710190046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636643",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636643",
            "telephone_number": "440-989-3801",
            "fax_number": "440-690-0264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6115 EMERALD ST",
            "city": "N RIDGEVILLE",
            "state": "OH",
            "postal_code": "440392047",
            "telephone_number": "440-406-5800",
            "fax_number": "216-201-6914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTOCZAK",
        "first_name": "DOUGLAS",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35060432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3025372",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0897874",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "douglaspotoczak@uhps.allscripts.net",
            "affiliation": "N",
            "address_1": "6115 Emerald St",
            "city": "N Ridgeville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440392047",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "douglaspotoczak@uhps.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "6115 Emerald St",
            "city": "N Ridgeville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440392047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in N Ridgeville, OH

Sources for this page

Verify at the official NPI Registry.