Doreen L Potter, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

005062 Issued in NY

Practice address

1134 State Route 29
Greenwich Family Health Center
Greenwich, NY 12834-6107

Phone

(518) 692-9861

Fax

(518) 692-7947

NPI assigned

Dec 19, 2005

Last updated

Jul 13, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Saratoga Psychiatric and Associated Services PC

  dba Bick Wanck MD and Associates

  • Psychiatry Physician
  • Saratoga Springs, NY
  • NPI 1245414168

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342137600000",
    "number": "1740266113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 304",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128010304",
            "telephone_number": "518-692-9861",
            "fax_number": "518-692-7947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1134 STATE ROUTE 29",
            "address_2": "GREENWICH FAMILY HEALTH CENTER",
            "city": "GREENWICH",
            "state": "NY",
            "postal_code": "128346107",
            "telephone_number": "518-692-9861",
            "fax_number": "518-692-7947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "DOREEN",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-19",
        "last_updated": "2012-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "005062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00370312",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02347400",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rose Marie Page, CCC-SLP
• William A Papura, DO
• Tricia J Pasos, DC
• Nina J Pollic, OPTICIAN
• Blake Anthony Porter, RPH
• Richard S Price, OD
• Eileen Marie Reid, RN
• Stuart Ira Rosenblatt, PH.D.
• Barney Rubenstein, MD
• Michele M Ruland, LCSW

• Physician Assistant in Greenwich, NY
• Providers in Greenwich, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.