NPIMap

Individual provider Active NPI

Brian J Pottorf, MD

  • Surgery Physician
  • Fayetteville, AR
National Provider Identifier
1760610307
Registry record updated Feb 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
E-13809 Issued in AR
Practice address
3264 N North Hills Blvd
Fayetteville, AR 72703-4005
Phone
(479) 521-3300
Fax
(479) 521-4705
NPI assigned
Jun 22, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X DR.0053920 CO
Surgery Physician 208600000X E-13809 AR Primary

Addresses

Primary practice location

3264 N North Hills Blvd
Fayetteville, AR 72703-4005

Mailing address

PO Box 550
Lowell, AR 72745-0550
Phone (479) 463-7775

Other practice location 1

12253 E 104th Pl # 100
Commerce City, CO 80022-2095
Phone (720) 282-8005

Other identifiers 1

IdentifierTypeStateIssuer
53920OtherCOCOLORADO MEDICAL BOARD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20210122000429 AR Practitioner - General Surgery 9638397334 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington Regional Medical SystemGroup PAC ID 8820995434, 238 clinicians

Practice addresses (Care Compare)

3 E Appleby Rd
Suite 401
Fayetteville, AR 72703-3163
Phone (479) 404-2500

Hospital & facility affiliations

  • Washington Regional Medical Center Hospital, Fayetteville, AR, CCN 040004

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue13
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0053920COMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Regional Medical System CurrentSince Jan 1, 2021 Accepting new patients
Washington Regional Medical System Current Accepting new patients
Washington Regional Medical System CurrentSince Jan 1, 2021 Accepting new patients
Washington Regional Medical System Past Accepting new patients

Locations

3 E Appleby Rd
Ste 401
Fayetteville, AR 72703
Phone (479) 404-2500

114 E Sunbridge Dr
Fayetteville, AR 72703
Phone (479) 463-2597

Interoperability endpoints

  • FHIR API: https://epicproxy.et1440.epichosted.com/APIProxyPRD/WRMSMYC/api/FHIR/R4
  • Direct secure messaging: bpottorf23128@washingtonregional.direct-ci.com
  • Direct secure messaging: brian.pottorfmd.p1@direct.fsa.nextgenshare.com

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 1

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": "1245628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1760610307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727450550",
            "telephone_number": "479-463-7775",
            "fax_number": "479-463-7187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 N NORTH HILLS BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034005",
            "telephone_number": "479-521-3300",
            "fax_number": "479-521-4705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12253 E 104th Pl # 100",
            "address_purpose": "LOCATION",
            "city": "Commerce City",
            "state": "CO",
            "postal_code": "800222095",
            "country_code": "US",
            "telephone_number": "720-282-8005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POTTORF",
        "first_name": "BRIAN",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-22",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CO",
            "license": "DR.0053920",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "E-13809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO MEDICAL BOARD",
            "identifier": "53920",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.