STEPHANIE ROSS POTTS PHD
NPI 1144873159
Clinical Neuropsychologist in Oshkosh, WI
NPI Status: Active since July 18, 2019
Contact Information
700 N WESTHAVEN DR
OSHKOSH, WI
ZIP 54904
Phone: (920) 456-2030
- Individual
- Female
- Years of Experience 9
- Clinical Neuropsychologist
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
About STEPHANIE POTTS
This page provides the complete NPI Profile along with additional information for Stephanie Potts, a provider established in Oshkosh, Wisconsin with a medical specialization in Clinical Neuropsychologist and more than 9 years of experience. The healthcare provider is registered in the NPI registry with number 1144873159 assigned on July 2019. The practitioner's primary taxonomy code is 103G00000X with license number 5131 (WI). The provider is registered as an individual and her NPI record was last updated one year ago.
- NPI
- 1144873159
- Provider Name
- STEPHANIE ROSS POTTS PHD
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 700 N WESTHAVEN DR OSHKOSH, WI 54904
- Location Phone
- (920) 456-2030
- Mailing Address
- PO BOX 735044 CHICAGO, IL 60673
- Mailing Phone
- (800) 326-2250
- Medical School Name
- OTHER
- Graduation Year
- 2017
- Is Sole Proprietor?
- No
- Enumeration Date
- 07-18-2019
- Last Update Date
- 09-10-2024
- Code Navigator
Location Map
Secondary Locations
- 1451 Merchant Dr
Algonquin, IL 60102
(847) 469-7537
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinical Neuropsychologist
- Taxonomy Code
- 103G00000X
- Type
- Behavioral Health & Social Service Providers
- License No.
- 5131
- License State
- WI
- Taxonomy Description
- A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 071.010747 (IL) |
| 2 | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 2018013237 (MO) |
| 3 | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | 2018013237 (MO) |
| 4 | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | 071.010747 (IL) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Bronze 1 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - HMO
- Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - HMO
- Gold 3 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision + Rx Copay - HMO
- Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - HMO
- Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - PPO
- Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Silver 5 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - HMO
- Silver 5 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision + Rx Copay - HMO
- Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - PPO
- Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Bronze Preferred/Broad HSA (+ Incentives) - POS
- Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Bronze Priority/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - HMO
- Anthem Bronze Priority/Lean HSA (+ Incentives) - HMO
- Anthem Bronze Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Priority/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Anthem Gold Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Anthem Heart Healthy Bronze Preferred/Broad 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) - POS
- Anthem Heart Healthy Bronze Priority/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) - HMO
- Anthem Silver Preferred/Broad 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Silver Priority/Lean 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - HMO
- Anthem Silver Priority/Lean 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives) - HMO
- Anthem Silver Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- HMO Bronze $0 Medical Deductible - HMO
- HMO Bronze 7500 - HMO
- HMO Catstrophic 9200 with 3 Free PCP Visits - HMO
- HMO Gold 1500 - HMO
- HMO Gold 2400 - HMO
- HMO HDHP Bronze 7200 - HMO
- HMO HDHP Silver 5400 - HMO
- HMO Silver 5000 - HMO
- HMO Silver 6600 - HMO
- POS Bronze 7500 - POS
- POS HDHP Bronze 6250 - POS
- POS Silver 5000 - POS
- Blue Precision Bronze HMO? 205 - HMO
- Blue Precision Bronze HMO? 701 - HMO
- Blue Precision Bronze HMO? Standard - Select Rx Copays - HMO
- Blue Precision Gold HMO? 207 - HMO
- Blue Precision Gold HMO? 703 - HMO
- Blue Precision Gold HMO? Standard - Rx Copays - HMO
- Blue Precision Silver HMO? 206 - HMO
- Blue Precision Silver HMO? 704 - HMO
- Blue Precision Silver HMO? Standard - Select Rx Copays - HMO
- MyBlue Plus Bronze? 903 - POS
- MyBlue Plus Bronze? 912 - POS
- MyBlue Plus Bronze? Standard - Select Rx Copays - POS
- MyBlue Plus Gold? 909 - POS
- MyBlue Plus Gold? 910 - POS
- MyBlue Plus Gold? Standard - Rx Copays - POS
- MyBlue Plus Silver? 905 - POS
- MyBlue Plus Silver? 906 - POS
- MyBlue Plus Silver? Standard - Select Rx Copays - POS
- Connect Bronze 2000 Indiv Med Deductible - HMO
- Connect Bronze 5000 Indiv Med Deductible - Rx Copay - HMO
- Connect Bronze CMS Standard - HMO
- Connect Gold CMS Standard - Rx Copay - HMO
- Connect Silver 3000 Indiv Med Deductible - Rx Copay - HMO
- Connect Silver CMS Standard - HMO
- CGHC Bronze $0 Ded / $2250 Rx Ded - Envision Network - EPO
- CGHC Bronze $0 Ded / $2250 Rx Ded - Envision Network (Vision Exam) - EPO
- CGHC Bronze $9200 ($40 PCP Copay) - Envision Network - EPO
- CGHC Bronze $9200 ($40 PCP Copay) - Envision Network (Vision Exam) - EPO
- CGHC Bronze Standard $7500 - Envision Network - EPO
- CGHC Bronze Standard $7500 - Envision Network (Vision Exam) - EPO
- CGHC Catastrophic $9200 - Envision Network - EPO
- CGHC Gold $0 Ded - Envision Network - EPO
- CGHC Gold $0 Ded - Envision Network (Vision Exam) - EPO
- CGHC Gold $3000 - Envision Network - EPO
- CGHC Gold $3000 - Envision Network (Vision Exam) - EPO
- CGHC Gold Standard $1500 - Envision Network - EPO
- CGHC Gold Standard $1500 - Envision Network (Vision Exam) - EPO
- CGHC Silver $4200 Ded / $5000 Rx Ded - Envision Network - EPO
- CGHC Silver $4200 Ded / $5000 Rx Ded - Envision Network (Vision Exam) - EPO
- CGHC Silver $4700 Ded / $6000 Rx Ded - Envision Network - EPO
- CGHC Silver $4700 Ded / $6000 Rx Ded - Envision Network (Vision Exam) - EPO
- CGHC Silver Standard $5000 - Envision Network - EPO
- CGHC Silver Standard $5000 - Envision Network (Vision Exam) - EPO
- Atlas $1,000 Gold - PPO
- Atlas $1,500 Standard Gold - PPO
- Atlas $2,650 Plus Silver - PPO
- Atlas $3,500 HSA Silver - PPO
- Atlas $5,000 Standard Silver - PPO
- Atlas $6,500 Plus Bronze - PPO
- Atlas $7,500 Standard Bronze - PPO
- Atlas $8,200 HSA Bronze - PPO
- Atlas $9,200 Catastrophic - PPO
- Robin Oak $1,000 Gold - PPO
- Robin Oak $1,500 Standard Gold - PPO
- Engage by Medica Bronze HSA - EPO
- Engage by Medica Bronze Share - EPO
- Engage by Medica Expanded Bronze Standard - EPO
- Engage by Medica Gold $0 Copay PCP Visits - EPO
- Engage by Medica Gold Share - EPO
- Engage by Medica Gold Standard - EPO
- Engage by Medica Silver $0 Copay PCP Visits - EPO
- Engage by Medica Silver Share - EPO
- Engage by Medica Silver Standard - EPO
- Essentia Choice Care with Medica Bronze HSA - EPO
- Essentia Choice Care with Medica Bronze Share - EPO
- Essentia Choice Care with Medica Expanded Bronze Standard - EPO
- Essentia Choice Care with Medica Gold $0 Copay PCP Visits - EPO
- Essentia Choice Care with Medica Gold Share - EPO
- Essentia Choice Care with Medica Gold Standard - EPO
- Essentia Choice Care with Medica Silver $0 Copay PCP Visits - EPO
- Essentia Choice Care with Medica Silver Share - EPO
- Essentia Choice Care with Medica Silver Standard - EPO
- Medica Individual Choice Bronze HSA - EPO
- Medica Individual Choice Bronze Share - EPO
- Gold 1 - HMO
- Gold 1 with Adult Vision Services - HMO
- Gold 8 - HMO
- Silver 1 - HMO
- Silver 1 with Adult Vision Services - HMO
- Silver 12 with First 4 Primary Care Visits Free - HMO
- Silver 8 - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE $0 MEDICAL DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE $7250 HSA - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE (DENTAL & VISION) $0 MEDICAL DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE (DENTAL & VISION) STANDARD EASY PRICING - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE STANDARD EASY PRICING - HMO
- QUARTZ GUNDERSEN PERFORMANCE CATASTROPHIC $9200 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD $2500 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD (DENTAL & VISION) $2500 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD (DENTAL & VISION) STANDARD EASY PRICING - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD MAINTENANCE $500 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD MAINTENANCE (DENTAL & VISION) $500 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD STANDARD EASY PRICING - HMO
- QUARTZ GUNDERSEN PERFORMANCE SILVER $0 DED FLAT RX COPAYS - HMO
- QUARTZ GUNDERSEN PERFORMANCE SILVER $7000 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $0 DED FLAT RX COPAYS - HMO
- QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $7000 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) STANDARD EASY PRICING - HMO
- QUARTZ GUNDERSEN PERFORMANCE SILVER STANDARD EASY PRICING - HMO
- QUARTZ ONE ACHIEVE BRONZE (DENTAL & VISION) $9100 DED FLAT RX COPAYS - IL - HMO
- QUARTZ ONE ACHIEVE BRONZE (DENTAL & VISION) STANDARD EASY PRICING - IL - HMO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - HMO
- UHC Bronze Standard (No Referrals) - HMO
- UHC Bronze Value HSA (No Referrals) - HMO
- UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - HMO
- UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
- UHC Gold Standard (No Referrals) - HMO
- UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
- UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - HMO
- UHC Silver Standard (No Referrals) - HMO
- UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 100266414 | MEDICAID (05) | WI |
Medicare Participation & PECOS Enrollment Status
Stephanie Potts is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Stephanie Potts is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging and Durable Medical Equipment (DME).
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 1254661432
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20240305000850
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): No
Eligible to Order or Refer Power Mobility Devices: No
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 4 | 4 | 8 | 7 | 3 | 1 | 5 | 9 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 8 | 4 | 16 | 7 | 6 | 1 | 10 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 8 + 4 + 1 + 6 + 7 + 6 + 1 + 1 + 0 + 24 = 61 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 61 = 9 | 9 | ||||||||
The NPI number 1144873159 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1588612311 | MICHAEL T SCHAFER MSW Individual | Counselor | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 303-8700 |
| 1487761920 | MS. KATHLEEN K KRAUS LPC Individual | Counselor | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 303-8700 |
| 1396942157 | AURORA MEDICAL GROUP, INC. Organization | Durable Medical Equipment & Medical Supplies | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 303-8700 |
| 1902130297 | AURORA VISION CENTER Organization | Optometrist | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 456-2000 |
| 1942294517 | CYNTHIA C LEIGH MD Individual | Internal Medicine (Endocrinology, Diabetes & Metabolism) | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 303-8700 |
| 1992141246 | DIANNE W SELLERS NP Individual | Nurse Practitioner (Adult Health) | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 303-8700 |
| 1124465620 | MR. GREGG ROBERT BREWER M.S. Individual | Social Worker (Clinical) | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 456-2030 |
| 1790045979 | MS. AMY LEIGH PARMLEY M.S.E., Individual | Counselor | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 456-2030 |
| 1205943115 | MS. DEBBIE A ZWICKEY LCSW Individual | Social Worker | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 303-8700 |
| 1841719135 | MR. DANIEL JOHN THIEL RN, CDE Individual | Registered Nurse (Diabetes Educator) | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 303-8700 |
| 1518952829 | MRS. CHERYL ANN PUCCI APNP Individual | Nurse Practitioner (Family) | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 969-1768 |
| 1316496565 | SUSAN SAMPLE NP Individual | Nurse Practitioner (Psychiatric/Mental Health) | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 456-2030 |
| 1578579637 | KARIN SUESSER PHD Individual | Psychologist | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 303-8700 |
| 1255686416 | LINDSAY W DAVEL DNP, APNP Individual | Nurse Practitioner (Psychiatric/Mental Health) | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 456-2030 |
| 1255698551 | GAYLE A JOHNSON LPC Individual | Counselor (Professional) | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 303-8800 |
| 1598248890 | JULIE A PALUCH LCSW Individual | Social Worker (Clinical) | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 456-2030 |
| 1699127571 | SANDRA VERHAEGHE O.D. Individual | Optometrist | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 303-8700 |
| 1912252198 | TARRA ANNE COMBS Individual | Clinical Neuropsychologist | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 456-2030 |
| 1770218976 | TRICIA L SNOW-NAULT NP Individual | Nurse Practitioner | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 303-8700 |
| 1275640385 | DR. AMY C TREICHEL BRANDT OD Individual | Optometrist | 700 N WESTHAVEN DR OSHKOSH, WI 54904 (920) 456-2000 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1144873159, enumerated in the NPI registry as an "individual" on July 18, 2019
The provider is located at 700 N Westhaven Dr Oshkosh, Wi 54904 and the phone number is (920) 456-2030
The provider's speciality is Clinical Neuropsychologist with taxonomy code 103G00000X
The provider has more than 9 years of experience.
The provider might be accepting Accepts: Aetna CVS Health, Anthem Blue Cross and Blue. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging and Durable Medical Equipment (DME).
This NPI record was last updated on July 18, 2019. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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