BRANDON JOHN POTTERS (NPI# 1245751460) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1245751460 |
Entity Type | Individual |
Full Name | BRANDON JOHN POTTERS |
Credential | IDC |
Practice Address |
Air Test and Evaluation Squadron Nine Rd 187 Rd Edwards Afb CA 93524-0001 |
Mailing Address |
Air Test and Evaluation Squadron Nine Rd 187 North Flightline Road Edwards Afb CA 93524-0001 |
Practice Telephone | 6618601540 |
Enumeration Date | 2017-06-28 |
Last Update Date | 2017-06-28 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
Street Address |
AIR TEST AND EVALUATION SQUADRON NINE RD 187 RD |
City | EDWARDS AFB |
State | CA |
Zip Code | 93524-0001 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1114540499 | Nathaniel George Brown | Student in an Organized Health Care Education/Training Program | 412th Medical Group 30 Nightingale Rd., Building #5525, Edwards Air Force Base, CA 93524 | 2020-05-21 |
1265852396 | Wesley John Fischer | Pharmacist | 30 Nightengale Road, Edwards U.S. Air Force Base Pharmacy, Edwards, CA 93524 | 2014-04-16 |
1659567493 | Kevin Ray Hooker | Social Worker | 30 Nightingale Road, 5513, Lancaster, CA 93524 | 2007-09-14 |
1336655943 | Keith Janda | Physician Assistant | 95th Medical Group 30 Nightingale Road Building 5525, Edwards Afb, CA 93524-0001 | 2017-12-19 |
1598286049 | Mackenzie Johnson Clevenger | Pharmacist | 412 Mdg 30 Nightingale Rd, Edwards Afb, CA 93524-0001 | 2017-07-05 |
1003266073 | Meshva Akwalia | Pediatrics | 412 Medical Group 30 Nightingale Rd Bldg 5525, Edwards Afb, CA 93524-0001 | 2016-06-20 |
1144613670 | Pang Ko | Dentist | 30 Nightingale Ave Building 5513, Edwards, CA 93524-0001 | 2015-03-09 |
1710293345 | Tonya Nicole Barry | Dentist | Bldg 3925, 31 Nightingale Rd, Edwards Afb, CA 93524-0001 | 2010-08-20 |
1265761340 | Shanda R. Marshall | Nurse Practitioner | 412 Th Medical Grouup, 30 Nightingale Road, Edwards, CA 93524-0001 | 2009-12-18 |
1639300197 | Moises Velasco | Military Health Care Provider | 412 Th Medical Group, 30 Nightingale Rd., Edwards Afb, CA 93524-0001 | 2009-07-31 |
Find all providers in zip 93524 |
Taxonomy Code | 1710I1002X |
Grouping | Other Service Providers |
Classification | Military Health Care Provider |
Specialization | Independent Duty Corpsman |
A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1316547227 | Landri Acosta | Military Health Care Provider | 5075 Tranquil Way # 102, Oceanside, CA 92057-7870 | 2020-10-29 |
1649879537 | David Michael Soliani | Military Health Care Provider | Bld 4101 Stuart Mesa Road, Camp Pendleton, CA 92055-5584 | 2020-10-21 |
1801494182 | Luis Alberto Necoechea | Military Health Care Provider | 1st Recon Bn Bas, Oceanside, CA 92055 | 2020-10-09 |
1770180648 | Darius Lee Sean Woods | Military Health Care Provider | 6033 Sandy Shore Ct, San Diego, CA 92139-1014 | 2020-10-05 |
1174130744 | Daniel Carrera | Military Health Care Provider | 2645 W Canyon Ave Apt 450, San Diego, CA 92123-4700 | 2020-09-28 |
1316551740 | Kyle Bode Francis | Military Health Care Provider | 3149 Murray Ridge Rd, San Diego, CA 92123-2917 | 2020-09-02 |
1356955918 | Daniel Carr | Military Health Care Provider | 5423 Lake Murray Blvd Apt 7, La Mesa, CA 91942-1551 | 2020-09-01 |
1255945069 | Jeremy Lee | Military Health Care Provider | 509 Dennery Rd Apt 145, San Diego, CA 92154-8542 | 2020-08-31 |
1639782899 | Tyler Collin Sparks | Military Health Care Provider | 1 Mrb, Camp Pendletion, CA 92055 | 2020-08-27 |
1013520667 | Rashaad Brown | Military Health Care Provider | 4454 Cherokee Ave Apt 2, San Diego, CA 92116-3611 | 2020-08-24 |
Find all providers with the same taxonomy |
City | EDWARDS AFB |
Zip Code | 93524 |
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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.