Tyler J Potter, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12010184A Issued in IN

Practice address

1630 W Smith Valley Rd
Greenwood, IN 46142-1550

Phone

(317) 882-3370

Fax

(317) 882-2964

NPI assigned

Jun 15, 2006

Sex

Male

Sole proprietor

No

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.

• Indiana Oral & Maxillofacial Surgery Associates PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Fishers, IN
  • NPI 1407809585
  Medicare reassignment Care Compare group NPD IN, Oral and Maxillofacial Surgery
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

Specialty

Maxillofacial Surgery

Education

Indiana University School of Dentistry, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Indiana Oral and Maxillofacial Surgery Associates PC 11 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in IN

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.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 31, 2012.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346371200000",
    "number": "1992749402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10972 ALLISONVILLE RD",
            "address_2": "SUITE 110",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460382637",
            "telephone_number": "317-913-2363",
            "fax_number": "317-913-2360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 W SMITH VALLEY RD",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461421550",
            "telephone_number": "317-882-3370",
            "fax_number": "317-882-2964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "TYLER",
        "middle_name": "J",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2012-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12010184A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200449320",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric D Poplin
• Christina Elizabeth Popoviciu, DDS
• Amanda Marie Popplewell
• Porch Light Senior Care Inc
• Hailey Dawn Potter
• Emma Jane Powell, MS OTR
• India Powell
• Ross S Powell, DPT
• Aryanna Praed
• Shimoga Ramaiah Prakash, M.D.

• All providers in Greenwood, IN
• Oral and Maxillofacial Surgery (Dentist) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2012; 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.