JASON J. POTOCKI (NPI# 1619998317) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619998317 |
| Entity Type | Individual |
| Full Name | JASON J. POTOCKI |
| Credential | M.D. |
| Practice Address |
3501 Cranberry Blvd Weston WI 54476-5213 |
| Mailing Address |
1000 N Oak Ave Marshfield WI 54449-5703 |
| Practice Telephone | 7153931000 |
| Mailing Telephone | 7153875511 |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2013-04-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 60046 | WI | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 064444 | GA | Allopathic & Osteopathic Physicians |
| Y | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
60046 | WI | Allopathic & Osteopathic Physicians |
| N | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
064444 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | PHYSICIAN LICENSE | 40457 | 01 |
| KY | ANTHEM | 000000485767 | 01 |
| NC | LICENSE | 200700867 | 01 |
| IN | PHYSICIAN LICENSE | 01062299A | 01 |
| IN | CSR | 01062299B | 01 |
| GA | LICENSE | 064444 | 01 |
| IN | IHCP | 200828920 | 01 |
| Street Address |
3501 CRANBERRY BLVD |
| City | WESTON |
| State | WI |
| Zip Code | 54476-5213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972500718 | William J Moran | Otolaryngology | 3501 Cranberry Blvd, Weston, WI 54476-5213 | 2005-07-07 |
| 1356956015 | Stacey Lee Meyer | Nurse Practitioner | 3501 Cranberry Blvd, Weston, WI 54476-5213 | 2020-09-10 |
| 1992336655 | Mchs Hospitals, Inc. | Clinic/Center | 3501 Cranberry Blvd, Weston, WI 54476-5213 | 2020-01-31 |
| 1548804511 | Alyssa Anne Hovda | Dietitian, Registered | 3501 Cranberry Blvd, Weston, WI 54476-5213 | 2019-11-03 |
| 1144875824 | Rebecca Ann Kollross | Physician Assistant | 3501 Cranberry Blvd, Weston, WI 54476 | 2019-08-08 |
| 1891266060 | Laura Lauer | Nurse Practitioner | 3501 Cranberry Blvd, Weston, WI 54476-5213 | 2018-12-16 |
| 1356816201 | Khamal Misra | Nurse Practitioner | 3501 Cranberry Blvd, Weston, WI 54476-5213 | 2018-10-08 |
| 1164915971 | Crystal Farrand | Physician Assistant | 3501 Cranberry Blvd, Weston, WI 54476-5213 | 2018-06-07 |
| 1336663863 | Elijah Blair | Physician Assistant | 3501 Cranberry Blvd, Weston, WI 54476-5213 | 2017-07-26 |
| 1275915597 | Kari Mizgalski | Dietitian, Registered | 3501 Cranberry Blvd, Weston, WI 54476-5213 | 2015-06-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407406309 | Kelly Hodge | Technician | 118 Marguerite St, Schofield, WI 54476 | 2019-09-13 |
| 1427557529 | Brandon David Parmer | Licensed Practical Nurse | 134 Kurth St, Schofield, WI 54476 | 2018-02-05 |
| 1558880583 | Kellie Cares Medical, LLC | Non-emergency Medical Transport (VAN) | 4311 Schofield Ave, #97, Weston, WI 54476 | 2017-09-11 |
| 1679018022 | Alexis Legenza | Behavioral Analyst | 4601 Camp Phillips Rd, Weston, WI 54476 | 2016-12-21 |
| 1699176487 | Reenu Mathew | Pharmacist | 5305 U.S. Hwy Business 51, Weston, WI 54476 | 2014-09-11 |
| 1063812246 | Brian Weiland | Psychologist | 2405 Schofield Ave Ste 220, Weston, WI 54476 | 2014-08-25 |
| 1194087759 | Susan C Coady | Physical Therapist | 4605 Valres Springs Court, Weston, WI 54476 | 2012-06-11 |
| 1053437467 | Emmie Jo Kasat | Speech-Language Pathologist | 4605 Valdres Springs Court, Weston, WI 54476 | 2007-03-21 |
| 1326181322 | Lisa Marie Skutak | Dentist | 700 Eagle Nest Boulevard, Suite E, Rothschild, WI 54476 | 2007-02-15 |
| 1205976776 | Quirt Family Dentistry Sc | Dentist | 3417 Schofield Avenue, Schofield, WI 54476 | 2007-02-07 |
| Find all providers in zip 54476 | ||||
| Taxonomy Code | 207XS0117X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Orthopaedic Surgery of the Spine |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659879930 | Joint Replacement Cin of Milwaukee LLC | Orthopaedic Surgery | 310 E Buffalo St Ste 203, Milwaukee, WI 53202-5808 | 2018-01-31 |
| 1477051753 | Spine Cin of Milwaukee LLC | Orthopaedic Surgery | 310 E Buffalo St Ste 206, Milwaukee, WI 53202-5808 | 2018-01-31 |
| 1124359880 | Milwaukee Spinal Specialists, S.c. | Orthopaedic Surgery | 575 W. River Woods Pkwy, Suite 305, Milwaukee, WI 53212-1003 | 2010-01-20 |
| 1912919002 | Stephen P Delahunt | Orthopaedic Surgery | 2801 W Kinnickinnic River Pkwy Ste 355, Milwaukee, WI 53215-3695 | 2006-08-13 |
| 1104873652 | Mustafa Khan | Orthopaedic Surgery | 1218 W Kilbourn Ave Ste 301, Milwaukee, WI 53233-1325 | 2006-05-30 |
| 1003898255 | Clay Jamison Frank | Orthopaedic Surgery | 601 N 99th St, Suite 101, Wauwatosa, WI 53226-4339 | 2005-11-15 |
| 1770032765 | Waypoint Spine, S.c. | Orthopaedic Surgery | 520 Vincent St, Stevens Point, WI 54481-1848 | 2016-10-01 |
| 1386061844 | Mary Lundgren | Orthopaedic Surgery | 3033 W Layton Ave, Greenfield, WI 53221-2628 | 2014-03-23 |
| 1306054390 | Seth K. Williams | Orthopaedic Surgery | 621 Science Dr, Madison, WI 53711-1074 | 2007-05-21 |
| 1619018819 | Midwest Spinal Center | Orthopaedic Surgery | 2015 E Newport Ave, Suite 605, Milwaukee, WI 53211-2949 | 2007-02-09 |
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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.