Dorothea Poulos, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-066780 Issued in IL

Practice address

87 N Airlite St Ste 130
Elgin, IL 60123-4991

Phone

(847) 888-3661

Fax

(847) 888-9964

NPI assigned

Oct 10, 2005

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1003804519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87 N AIRLITE ST STE 130",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601234991",
            "telephone_number": "847-888-3661",
            "fax_number": "847-888-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 N AIRLITE ST STE 130",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601234991",
            "telephone_number": "847-888-3661",
            "fax_number": "847-888-9964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1435 N Randall Rd Ste 301",
            "address_purpose": "LOCATION",
            "city": "Elgin",
            "state": "IL",
            "postal_code": "601232304",
            "country_code": "US",
            "telephone_number": "847-888-3661",
            "fax_number": "847-888-9964",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POULOS",
        "first_name": "DOROTHEA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-10",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-066780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036066780",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD RETIREMENT BOARD",
            "identifier": "110021524",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dpoulos282793@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "87 N Airlite St Ste 130",
            "city": "Elgin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601234991",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Amanda Jean Powell, RN, APN, FNP-C
• Keyana Powell
• Eva B Powers, MS
• Lauren Powers
• Prairie Foot & Ankle, P.C.

• Family Medicine Physician in Elgin, IL
• Providers in Elgin, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.