CHARLES R. POTTER, M.D., L.L.C. (NPI# 1538254727) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538254727 |
| Entity Type | Organization |
| Organization Name | CHARLES R. POTTER, M.D., L.L.C. |
| Practice Address |
1770 E Lake Shore Dr Suite 306 Decatur IL 62521-3832 |
| Practice Telephone | 2174221199 |
| Practice Fax Number | 2174221277 |
| Mailing Telephone | 2174221199 |
| Mailing Fax Number | 2174221277 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2008-06-19 |
| Authorized Official Name | DR. CHARLES R POTTER (OWNER) |
| Authorized Official Telephone | 2174221199 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | 036-065056 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
1770 E LAKE SHORE DR SUITE 306 |
| City | DECATUR |
| State | IL |
| Zip Code | 62521-3832 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942292412 | David Anthony Jones | Family Medicine | 1770 E Lake Shore Dr, Suite 305, Decatur, IL 62521-3832 | 2005-08-19 |
| 1306314778 | Kristy Dawn Shafer | Nurse Practitioner | 1770 E Lake Shore Dr, Decatur, IL 62521-3832 | 2018-11-05 |
| 1902340730 | Annie Michele Smith | Social Worker | 1770 E Lake Shore Dr, #209, Decatur, IL 62521-3832 | 2016-12-13 |
| 1013319623 | Nicole Marie Lord | Nurse Practitioner | 1770 E Lake Shore Dr, #309, Decatur, IL 62521-3832 | 2014-09-25 |
| 1508110198 | Leslie Stanislaus Anewenah | Surgery | 1770 E Lake Shore Dr, Decatur, IL 62521-3832 | 2012-11-04 |
| 1063797108 | Laurel A Walton Do Sc | Obstetrics & Gynecology | 1770 E Lake Shore Dr, Ste 309, Decatur, IL 62521-3832 | 2011-10-20 |
| 1447532924 | Ahmad H Ahmad Md Sc | Internal Medicine | 1770 E Lake Shore Dr, Ste 201, Decatur, IL 62521-3832 | 2011-09-12 |
| 1912233602 | Linda Wilson Klemm | Nurse Practitioner | 1770 E Lake Shore Dr, Suite 105, Decatur, IL 62521-3832 | 2009-10-30 |
| 1265675490 | Jennifer Ross-barnett | Nurse Practitioner | 1770 E Lake Shore Dr, Suite 207, Decatur, IL 62521-3831 | 2009-04-17 |
| 1447403936 | Choudary V. Kavuri Md, Sc | Psychiatry & Neurology | 1770 E Lake Shore Dr, Suite 208, Decatur, IL 62521-3832 | 2008-10-28 |
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|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679720726 | Waymond Jay Pettit | Otolaryngology | 3620 S Taylor Rd, Decatur, IL 62521-9015 | 2008-08-20 |
| 1104883735 | Stephen J Chadwick | Otolaryngology | 101 W Mckinley Ave, Enta Allergy, Head & Neck Institute, Decatur, IL 62522 | 2006-04-27 |
| 1174589634 | Joanne Pham | Otolaryngology | 1600 W Business 380, Suite A, Decatur, TX 76234-3281 | 2006-04-25 |
| 1851356083 | Willis P Callins | Otolaryngology | 4288 Memorial Dr, Ste D, Decatur, GA 30032-1229 | 2006-04-19 |
| 1265413124 | Sage Kinney Copeland | Otolaryngology | 1218 13th Ave Se, Decatur, AL 35601-4307 | 2005-11-08 |
| 1275531907 | Jenny Christine Kim | Otolaryngology | 484 Irvin Ct, Ste 140, Decatur, GA 30030-5406 | 2005-07-07 |
| 1275857542 | Shivan H Amin | Otolaryngology | 2675 N Decatur Rd, Ste 707, Decatur, GA 30033-6131 | 2010-03-16 |
| 1568646842 | Jeffrey Michael Ulis | Otolaryngology | 101 W Mckinley Ave, Decatur, IL 62526-3286 | 2007-12-22 |
| 1760597363 | Michelle Marie Cullen | Otolaryngology | 1670 Clairmont Rd, Decatur, GA 30033-4004 | 2006-08-21 |
| 1528026580 | Terence R Woods | Otolaryngology | 101 W Mckinley Ave, Enta Allergy, Head & Neck Institute, Decatur, IL 62526 | 2006-05-01 |
| Find all providers in DECATUR | ||||
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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.