Gregory L Potts, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149014179 Issued in IL

Practice address

4740 N Clark St
Chicago, IL 60640-4689

Phone

(773) 769-0205

Fax

(773) 765-0794

NPI assigned

Jul 8, 2011

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 4, 2024 through Dec 4, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Samaritan Counseling Center

  • Marriage & Family Therapist
  • Winnetka, IL
  • NPI 1841397353
  NPD (past)

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

{
    "created_epoch": "1310083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1891082947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 W HAWTHORNE PL APT 308",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606579266",
            "telephone_number": "773-655-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404689",
            "telephone_number": "773-769-0205",
            "fax_number": "773-765-0794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTS",
        "first_name": "GREGORY",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-08",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149014179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1616824",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Leslie Potter, MHS CCC SLP
• Renee Potter, LCSW
• Carolyn Potts
• Carson Potts
• Derek William Potts
• James Kenneth Potts, DDS
• Janna Potts
• Matthew B Potts, MD
• Steven Potts, DO
• Sajana Poudel, MD

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.