Active NPI
Reynald Pouliot, M.D.
- Obstetrics & Gynecology Physician
- Lauderdale by the Sea, FL
National Provider Identifier
1003882069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- ME 36312
- Practice address
- 265B Commercial Blvd
Lauderdale by the Sea, FL 33308-4442 - Phone
- (954) 772-3960
- Fax
- (954) 772-3981
- NPI assigned
- Feb 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | ME 36312 | FL | Primary |
Addresses
Primary practice location
265B Commercial Blvd
Lauderdale by the Sea, FL 33308-4442
Mailing address
265B Commercial Blvd
Lauderdale by the Sea, FL 33308-4442
Phone (954) 772-3960
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 065023400 | Medicaid | FL | |
| 4421890 | Other | FL | AETNA PPO |
| 07023720 | Other | FL | UNITED |
| 2080754 | Other | FL | AETNA HMO |
| 93842 | Other | FL | BC/BS OF FL |
| 257650 | Other | FL | AVMED |
| 3967705006 | Other | FL | CIGNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Obstetrics/Gynecology
- Education
- Other, 1972
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
265 B Commercial Blvd
Lauderdale by the Sea, FL 33308-4442
Phone (954) 772-3960
3225 Aviation Ave
Suite 700
Miami, FL 33133-4741
Phone (305) 273-4641
Hospital & facility affiliations
- Holy Cross Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 36312 | FL | MD | Obstetrics & Gynecology Physician |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JJAACA/Endpoint/JJAACA
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Obstetrics & Gynecology Physician
- Miami, FL
- NPI 1871572032
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Ft Lauderdale, FL
- NPI 1639197395
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337040000000",
"number": "1003882069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "265B COMMERCIAL BLVD",
"city": "LAUDERDALE BY THE SEA",
"state": "FL",
"postal_code": "333084442",
"telephone_number": "954-772-3960",
"fax_number": "954-772-3981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "265B COMMERCIAL BLVD",
"city": "LAUDERDALE BY THE SEA",
"state": "FL",
"postal_code": "333084442",
"telephone_number": "954-772-3960",
"fax_number": "954-772-3981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POULIOT",
"first_name": "REYNALD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-28",
"last_updated": "2012-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "FL",
"license": "ME 36312",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "065023400",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "4421890",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED",
"identifier": "07023720",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "2080754",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF FL",
"identifier": "93842",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVMED",
"identifier": "257650",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "3967705006",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lauderdale by the Sea, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2012; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.