DR. CHAD JEREMY POTTER (NPI# 1972547180) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972547180 |
| Entity Type | Individual |
| Full Name | DR. CHAD JEREMY POTTER |
| Credential | MD |
| Practice Address |
3801 South National Springfield MO 65807 |
| Mailing Address |
1550 E Republic Rd Springfield MO 65804-6530 |
| Practice Telephone | 4172694056 |
| Practice Fax Number | 4172695556 |
| Mailing Telephone | 4178896102 |
| Mailing Fax Number | 4178896289 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2009-09-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
2006015225 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 201291606 | 05 | |
| MO | RRR MEDICARE | P00419521 | 01 |
| AR | 150984001 | 05 | |
| MO | BLUE | 1256 | 01 |
| Street Address |
3801 SOUTH NATIONAL |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396390241 | Karley Kassandra Murphy | Counselor | 3734 South Ave #c, Springfield, MO 65807 | 2019-08-07 |
| 1396203626 | Auvia L Logan | Dietitian, Registered | 3322 S. Campbell Ave. Suite Cc, Springfield, MO 65807 | 2019-03-05 |
| 1598250961 | Kathryn Barber | Nurse Practitioner | 3800 S National Ave Ste 700, Springfield, MO 65807 | 2018-06-27 |
| 1447764899 | Missouri Midwifery Service | Clinic/Center | 3840 South Avenue, Springfield, MO 65807 | 2017-11-21 |
| 1124530290 | Senior Living Management Group, LLC | Skilled Nursing Facility | 3705 S Jefferson Ave, Springfield, MO 65807 | 2017-10-30 |
| 1740663335 | Sarah E Kirk | Physical Therapist | 3545 S. National Ave, Springfield, MO 65807 | 2015-07-01 |
| 1750713335 | Amanda Ward | Nurse Practitioner | 2150 W Republic Rd Ste 112, Springfield, MO 65807 | 2013-08-06 |
| 1932531126 | Eugenia R Cortez | Counselor | 2124 Chesterfield Blvd., Springfield, MO 65807 | 2013-07-30 |
| 1962742866 | Missouri Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3045 W Republic St, Springfield, MO 65807 | 2013-03-01 |
| 1033462387 | Miguel Angel Medina | Physician Assistant | 1900 South Sunshine Ave., Springfield, MO 65807 | 2012-10-24 |
| Find all providers in zip 65807 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407389596 | Medical Mile Imaging | Radiology | 3905 E Windsmore Dr, Springfield, MO 65802 | 2017-04-06 |
| 1154738961 | Allison Kate Retzer | Radiology | 701 N 1st Box 101, Springfield, IL 62781-0001 | 2014-07-14 |
| 1134552821 | Clinical Radiologists, S.c. | Radiology | 2812 Pat Tillman Dr, Springfield, IL 62711-6410 | 2013-08-16 |
| 1700199668 | Telerad of Mo Account Management, LLC | Radiology | 5117 S. Neffleton Ave, Springfield, MO 65810 | 2010-07-21 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| 1316108434 | Michael C Snyder | Radiology | 2201 Greenside Dr, Springfield, IL 62704-3245 | 2008-06-20 |
| 1245416536 | Mary T Peter | Radiology | Springfield Radiologists St Johns Hospital, 800 E. Carpenter Street, Springfield, IL 62769-0001 | 2008-01-16 |
| 1437361060 | Kal Dulaimy | Radiology | 1350 Main Street Suite 1007, Radiology and Imaging, Inc., Springfield, MA 01103-0000 | 2007-05-04 |
| 1265654164 | Nzeadibenma O Uzochukwu | Radiology | 800 Carpenter St, Springfield, IL 62769-0001 | 2007-05-02 |
| 1396865838 | Charles X Stricker | Radiology | 4303 E Lori Lei Ct, Springfield, MO 65809-3501 | 2007-03-29 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 65807 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.