Matthew Allen Potter, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.005050 Issued in IL

Practice address

15127 S 73Rd Ave
Suite G
Orland Park, IL 60462-4398

Phone

(800) 361-6880

Fax

(708) 845-5505

NPI assigned

Oct 19, 2010

Sex

Male

Sole proprietor

Yes

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 IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chicago Christian Counseling Center IncGroup PAC ID 1052395258, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Chicago Christian Counseling Center Inc

  • Clinical Social Worker
  • Orland Park, IL
  • NPI 1083664510

  Professional

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415059200000",
    "number": "1881904266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15127 S 73RD AVE",
            "address_2": "SUITE G",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624398",
            "telephone_number": "800-361-6880",
            "fax_number": "708-845-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15127 S 73RD AVE",
            "address_2": "SUITE G",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624398",
            "telephone_number": "800-361-6880",
            "fax_number": "708-845-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "MATTHEW",
        "middle_name": "ALLEN",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-19",
        "last_updated": "2014-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.005050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Polito, MHS, CCC-SLP/L
• Amanda Pollock, PA-C
• Norma Ponce de Leon, R.D., LDN
• Benjamin Popp, DMD
• Anna Porcaro-Akan, CSW
• Deborah Jean Poulos
• Lea Powers
• Sheldon Pownall, MD
• Pradeep Thapar, MD.SC
• Pragathi Challa MD SC

• Professional Counselor in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; 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.