NPIMap

Lee Richard Potratz, PA-C, ATC

Individual provider Active NPI Surgical Physician Assistant · Bemidji, MN

NPI 1891787131 · NPPES record last updated Oct 4, 2019

Key facts

NPI
1891787131
Entity type
Individual (NPI type 1)
Primary specialty
Surgical Physician Assistant 363AS0400X
License
10848 (MN)
Practice address
1300 Anne St NW
Bemidji, MN 56601-5103
Phone
(218) 751-9746
NPI assigned
Aug 22, 2005
Sex
Male
Sole proprietor
No

Organizations & group practices 21

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.

Hospital & facility affiliations 3

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

Medicare Care Compare profile

Specialty
Physician Assistant
Education
University of North Dakota School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Health of Northern Minnesota (349 clinicians)

Practice addresses (Care Compare)

1300 Anne St NW
Bemidji, MN 56601-5103
Phone (218) 333-5000

1611 Anne St NW
Bemidji, MN 56601-5114
Phone (218) 333-5000

600 Main Ave S
Baudette, MN 56623-2855
Phone (218) 333-5100

Hospital & facility affiliations

  • Sanford Bemidji Medical Center Hospital · Bemidji, MN · CCN 240100
  • Lakewood Health Center Hospital · Baudette, MN · CCN 241301

Merit-based Incentive Payment System (MIPS)

Final score
86.56 of 100 (group)
Quality
74.25
Promoting interoperability
100
Improvement activities
40
Cost
76.16

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20110224000952 MN Practitioner - Physician Assistant 1052592920 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10848MNMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health of Northern Minnesota Current
since Jun 2, 2013		 Accepting new patients

Locations

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

1300 Anne St NW
Bemidji, MN 56601
Phone (218) 333-5794

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 1402 MN
Physician Assistant 363A00000X 10848 MN
Surgical Physician Assistant 363AS0400X 10848 MN Yes

Addresses

Primary practice location

1300 Anne St NW
Bemidji, MN 56601-5103

Mailing address

1233 34TH St NW
Bemidji, MN 56601-5112
Phone (218) 333-5171

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 4, 2019.

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570147200000",
    "number": "1891787131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 34TH ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015112",
            "telephone_number": "218-333-5171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 ANNE ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015103",
            "telephone_number": "218-751-9746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTRATZ",
        "first_name": "LEE",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "credential": "PA-C, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2019-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "1402",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10848",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "10848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bemidji, MN

All providers in Bemidji, MN · Surgical Physician Assistant in Minnesota

Sources for this page

Verify at the official NPI Registry.