THEODORE POTRUCH (MD) – Surgery Physician, NPI 1649225293

THEODORE POTRUCH (MD) is a healthcare provider. based in North las vegas, Nevada. specializing in Surgery Physician. They hold the professional credentials MD. They hold a License No. 3310 (NV). The NPI Number for THEODORE POTRUCH (MD) is 1649225293

Main info

Male
64 Years Of Experience
Accepts Medicare Assignment
Name
THEODORE POTRUCH (MD)
NPI
1649225293
Phone
(702) 333-1110
Address
2123 CIVIC CENTER DR
Enumeration Date
23 May 2006
Deactivation Date
22 January 2008
Reactivation Date
12 February 2008
Last Update Date
6 March 2018

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7023330110
Graduation Year
1962 (64 years ago)
PAC ID
7012017825
Group Practice PAC ID
9830472372
Professional Enrollment ID
I20080226000335
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

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Provider Addresses for THEODORE POTRUCH (MD)

  • 2123, Civic Center Drive, North Las Vegas, Clark County, Nevada, 89030, United States

    NORTH LAS VEGAS, NV 890306327

    Phone: (702) 333-1110

    Fax: (702) 685-0744

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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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.

No Medicare enrollment or revalidation data available for this provider in our database.

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 89030)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9830472372View full group profile
NameSpecialtyState
Clinical Social WorkerNV
Nurse PractitionerNV

Reviews

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Frequently asked questions

How do payers reference THEODORE POTRUCH (MD)?
For THEODORE POTRUCH (MD), use NPI 1649225293 as the unique 10-digit identifier.
Active or inactive — what applies to THEODORE POTRUCH (MD)?
You should see THEODORE POTRUCH (MD) as active in CMS-hosted NPPES data.
What expertise is attributed to THEODORE POTRUCH (MD)?
THEODORE POTRUCH (MD)'s specialty line reads Surgery Physician. Clinical services aligned with this taxonomy classification.
Is THEODORE POTRUCH (MD) associated with North Las Vegas?
Public fields place THEODORE POTRUCH (MD) around North Las Vegas, Nevada. Always confirm the exact site before visiting.
When was this NPI issued?
Enumeration for THEODORE POTRUCH (MD) is noted as May 23, 2006 where the registry provides it.

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