STEPHANIE KATHRYN POTTER (M.D.) – Family Medicine Physician, NPI 1609892413
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
971 FAMILY PRACTICE in ID
Provider Addresses for STEPHANIE KATHRYN POTTER (M.D.)
302 W Idaho St
Boise, ID 837026039
Phone: (208) 369-4590
Fax: (208) 906-2346
Type: Location
207 1st St S
Nampa, ID 836513703
Phone: (208) 466-7869
Fax: (208) 466-5359
Type: Location
1169 GRAND CENTRAL PKWY
CONROE, TX 773043185
Phone: (936) 525-3600
Fax: (936) 525-3624
Type: Mailing
College of Osteopathic Medicine of the Pacific-Northwest, 200, Mullins Drive, Lebanon, Linn County, Oregon, 97355, United States
LEBANON, OR 973553983
Phone: (541) 259-0200
Type: Mailing
302, West Idaho Street, Downtown, Boise, Ada County, Idaho, 83702, United States
BOISE, ID 837026039
Phone: (208) 369-4590
Fax: (208) 906-2346
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2009-07-31
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20090731000436 | I | Family Practice | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 83702)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | TX | |
| Osteopathic Manipulative Medicine | CT | |
| Internal Medicine, Pediatric Medicine | TX | |
| Internal Medicine, Pediatric Medicine | TX | |
| - | TX | |
| Emergency Medicine, Family Practice, Osteopathic Manipulative Medicine | TX | |
| Family Practice | TX | |
| Internal Medicine, Pediatric Medicine | TX | |
| - | NC | |
| Family Practice | MI |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.