Individual provider Active NPI

Kevin Wayne Potter, D.O.

  • Surgery Physician
  • Glendale, AZ
National Provider Identifier
1831355643
Registry record updated Jun 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
005313 Issued in AZ
Practice address
7330 N 99TH Ave Ste 200a
Glendale, AZ 85307-3018
Phone
(602) 406-3400
Fax
(602) 406-0270
NPI assigned
Jul 31, 2008
Last updated
Jun 8, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 005313 AZ Primary

Addresses

Primary practice location

7330 N 99TH Ave Ste 200a
Glendale, AZ 85307-3018

Mailing address

PO Box 33269
Phoenix, AZ 85067-3269
Phone (602) 406-4786

Other practice location 1

625 N 6th St Ste 402
Phoenix, AZ 85004-3067
Phone (602) 406-8222

Other identifiers 2

IdentifierTypeStateIssuer
445137MedicaidAZ
Z199540OtherAZMEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090812000783 AZ Practitioner - General Surgery 9638239031 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Practice addresses (Care Compare)

500 W Thomas Rd
680 DHMG St Joseph's Pelvic Pain and Surg
Phoenix, AZ 85013-4235
Phone (602) 406-6017

7330 N 99TH Ave
Glendale, AZ 85307-3003

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux15
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Josephs Pathology Current Accepting new patients
Sjhmc Physician Services CurrentSince Jul 11, 2011 Accepting new patients
Dignity Health Past Accepting new patients
Privia Medical Group Arizona, LLC Family Medicine Past Accepting new patients
Dignity Health Past Accepting new patients

Locations

7300 N 99th Ave
Glendale, AZ 85307
Phone (480) 339-5001

7330 N 99th Ave
Ste 200
Glendale, AZ 85307
Phone (602) 406-0033

7330 N 99th Ave
Ste 200A
Glendale, AZ 85307
Phone (602) 406-3400

7330 N 99th Ave
Ste 205
Glendale, AZ 85307
Phone (623) 209-1474

7330 N 99th Ave
Ste 325
Glendale, AZ 85307
Phone (480) 398-7620

222 W Thomas Rd
Ste 301
Phoenix, AZ 85013
Phone (602) 406-6900

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

500 W Thomas Rd
Ste 230
Phoenix, AZ 85013
Phone (602) 406-6700

500 W Thomas Rd
Ste 400
Phoenix, AZ 85013
Phone (602) 406-3874

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

500 W Thomas Rd
Ste 750
Phoenix, AZ 85013
Phone (602) 406-1150

File 56765
Los Angeles, CA 90074

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780876800000",
    "number": "1831355643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33269",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850673269",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7330 N 99TH AVE STE 200A",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853073018",
            "telephone_number": "602-406-3400",
            "fax_number": "602-406-0270"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "625 N 6th St Ste 402",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850043067",
            "country_code": "US",
            "telephone_number": "602-406-8222",
            "fax_number": "602-604-4722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POTTER",
        "first_name": "KEVIN",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-31",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "005313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "445137",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z199540",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.