Derick Aaron Potter, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP60630477 Issued in WA

Practice address

2690 NE Kresky Ave
Chehalis, WA 98532-2412

Phone

(360) 330-9595

Fax

(360) 330-9530

NPI assigned

Feb 4, 2016

Sex

Male

Sole proprietor

No

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

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Faith Home Care Practitioners PLLCGroup PAC ID 8426365412, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Assured Home Health and Hospice Home health agency, Centralia, WA, CCN 507042
• Providence at Home With Compassus, Puget Sound South Home health agency, Lacey, WA, CCN 507004
• Providence Centralia Hospital Hospital, Centralia, WA, CCN 500019

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: derick.potter.1@33184.direct.athenahealth.com

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.

• Faith Home Care Practitioners, PLLC

  • Family Nurse Practitioner
  • Chehalis, WA
  • NPI 1275917254
  Medicare reassignment Care Compare group NPD
• Lewis County Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Chehalis, WA
  • NPI 1134164692
  Medicare reassignment NPD
• Chanel Marie Tangen Patana

  • Pediatric Nurse Practitioner
  • Napavine, WA
  • NPI 1497317929
  Medicare reassignment
• Lewis County Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Centralia, WA
  • NPI 1437418175
  NPD
• Lewis County Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Centralia, WA
  • NPI 1811669658
  NPD
• Lewis County Pediatrics and Family Medicine

  • Primary Care Clinic/Center
  • Napavine, WA
  • NPI 1366247710
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• CP Sound Wa, LLC

  • Home Health Agency
  • Lacey, WA
  • NPI 1669294708
  Care Compare affiliation
• Northwest Healthcare Alliance, Inc.

  • Home Health Agency
  • Centralia, WA
  • NPI 1154397305
  Care Compare affiliation
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Centralia, WA
  • NPI 1376624981
  Care Compare affiliation

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

{
    "created_epoch": "1454544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454544000000",
    "number": "1811355803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2690 NE KRESKY AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322412",
            "telephone_number": "360-330-9595",
            "fax_number": "360-330-9530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2690 NE KRESKY AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322412",
            "telephone_number": "360-330-9595",
            "fax_number": "360-330-9530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "DERICK",
        "middle_name": "AARON",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-04",
        "last_updated": "2016-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60630477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert D Poaster, CRNA
• Darlene Poe
• Donna J Poe
• Brenda Polite, M.D.
• Sue Ann Poppe, SLPA
• Rachael Marie Potter, RN
• James Kyle Pratt, CDPT
• Traci Lynn Prayner, CRNA
• Stacie Anne Prestegord, LMP
• Coreenia Lee Preston, CNA

• Nurse Practitioner in Chehalis, WA
• Providers in Chehalis, WA by specialty
• Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.