NPIMap

Individual provider Active NPI

Susan Mary Potter, FNP

  • Nurse Practitioner
  • Sherman, TX
National Provider Identifier
1831270420
Registry record updated Jun 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
205349 Issued in OK
Practice address
500 N Highland Ave
Sherman, TX 75092-7354
Phone
(512) 730-3056
Fax
(888) 730-1925
NPI assigned
Oct 18, 2006
Last updated
Jun 2, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2022

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 520140 TX
Nurse Practitioner 363L00000X 205349 OK Primary
Family Nurse Practitioner 363LF0000X AP106025 TX
Gerontology Nurse Practitioner 363LG0600X AP106025 TN
Emergency Medicine Physician 207P00000X 520140 TX

Addresses

Primary practice location

500 N Highland Ave
Sherman, TX 75092-7354

Mailing address

7500 Rialto Blvd Ste 1-140
Austin, TX 78735-8534
Phone (512) 730-3056

Other practice location 1

400 S.W. 25th Avenue
Mineral Wells, TX 76067
Phone (940) 328-7503

Other practice location 2

609 Medical Center Dr
Decatur, TX 76234-3836
Phone (940) 627-5921

Other identifiers 1

IdentifierTypeStateIssuer
8N9964OtherTXBLUE CROSS & BLUE SHIELD

Other names 1

  • Susan Mary Kelly Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060316000530 TX Practitioner - Nurse Practitioner 2860409794 Reassigns benefits to 3 organizations
I20211005000965 OK Practitioner - Nurse Practitioner 2860409794 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Hospital Medicine Associates PCGroup PAC ID 4880841618, 17 clinicians

Practice addresses (Care Compare)

1201 Health Ctr Pkwy
Yukon, OK 73099-6381
Phone (405) 717-6800

2825 Parklawn Dr
Midwest City, OK 73110-4201
Phone (405) 610-4411

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
52014TXMDPharmacist
205349OKMDNurse Practitioner
AP106025TXMDFamily Nurse Practitioner
AP106025TNMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care of Oklahoma, Inc Current Accepting new patients
Emergency Physicians of Mid-America, P.C. Emergency Medicine CurrentSince Apr 1, 2024 Accepting new patients
Palo Pinto County Hospital District Family CurrentSince Jan 20, 2011 Accepting new patients
Midwest Hospital Medicine Associates PC Family CurrentSince May 5, 2022 Accepting new patients
Emergency Services of Oklahoma PC Emergency Medicine CurrentSince Jul 1, 2022 Accepting new patients
Palo Pinto County Hospital District Current Accepting new patients
Wise Emergency Medicine Associates PA Emergency Medicine CurrentSince Feb 15, 2013 Accepting new patients
Palo Pinto County Hospital District Family CurrentSince Jan 20, 2011 Accepting new patients
Clinton Hospital Authority CurrentSince Jun 11, 2024 Accepting new patients
Acs Primary Care Physicians Southwest, PA Emergency Medicine CurrentSince Aug 20, 2010 Accepting new patients
Palo Pinto County Hospital District Current Accepting new patients
Palo Pinto County Hospital District Nurse Practitioner Current Accepting new patients
Clinton Hospital Authority CurrentSince Jun 11, 2024 Accepting new patients
Emcare GLT Emergency Physicians PLLC Emergency Medicine Past Accepting new patients
Denton Erdocs PA Emergency Medicine Past Accepting new patients
Texas Em-I Medical Services, P.a. Emergency Medicine Past Accepting new patients

Locations

7106 Solutions Ctr
Chicago, IL 60677

100 N 30th St
Clinton, OK 73601
Phone (580) 323-2363

1000 N Lee Ave
Oklahoma City, OK 73102
Phone (405) 272-6152

1000 N Lee Ave
Rm 1921
Oklahoma City, OK 73102
Phone (405) 272-6053

2825 Parklawn Dr
Oklahoma City, OK 73110
Phone (405) 245-1453

3300 NW Expressway St
Oklahoma City, OK 73112
Phone (405) 251-2815

4050 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 608-3200

1102 W MacArthur St
Shawnee, OK 74804
Phone (405) 273-2270

1201 Health Center Pkwy
Yukon, OK 73099
Phone (405) 717-6800

2000 S FM 51
Decatur, TX 76234
Phone (940) 626-1848

609 Medical Center Dr
Decatur, TX 76234
Phone (940) 626-1360

2901 4th St
Longview, TX 75605
Phone (281) 371-1800

400 SW 25th Ave
Mineral Wells, TX 76067
Phone (940) 325-7891

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 11

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": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654128000000",
    "number": "1831270420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7500 RIALTO BLVD STE 1-140",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787358534",
            "telephone_number": "512-730-3056",
            "fax_number": "888-730-1925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N HIGHLAND AVE",
            "city": "SHERMAN",
            "state": "TX",
            "postal_code": "750927354",
            "telephone_number": "512-730-3056",
            "fax_number": "888-730-1925"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 S.W. 25th Avenue",
            "address_purpose": "LOCATION",
            "city": "Mineral Wells",
            "state": "TX",
            "postal_code": "76067",
            "country_code": "US",
            "telephone_number": "940-328-7503",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "609 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "TX",
            "postal_code": "762343836",
            "country_code": "US",
            "telephone_number": "940-627-5921",
            "fax_number": "940-626-1351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POTTER",
        "first_name": "SUSAN",
        "middle_name": "MARY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "520140",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OK",
            "license": "205349",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP106025",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TN",
            "license": "AP106025",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "520140",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "8N9964",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "KELLY",
            "middle_name": "MARY",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sherman, TX

Sources for this page

Verify at the official NPI Registry.