Active NPI
Lisa Gray Poole, CNM
- Midwife
- New Bern, NC
National Provider Identifier
1013131127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- 12177
- Practice address
- 2818 Neuse Blvd
New Bern, NC 28562 - Phone
- (252) 636-4920
- Fax
- (252) 636-4970
- NPI assigned
- Apr 12, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Midwife | 176B00000X | 12177 | NC | Primary |
Addresses
Primary practice location
2818 Neuse Blvd
New Bern, NC 28562
Mailing address
PO Drawer 12610
2818 Neuse Blvd
New Bern, NC 28562
Phone (252) 636-4920
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZM0000024 | Other | NC | NC PHARMACY BOARD |
| 383 | Other | NC | NC CNM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12177 | NC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Pitt Office of Auditor | Past | Accepting new patients |
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.
-
- State or Local Public Health Clinic/Center
- Greenville, NC
- NPI 1306904917
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013131127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO DRAWER 12610",
"address_2": "2818 NEUSE BLVD",
"city": "NEW BERN",
"state": "NC",
"postal_code": "28562",
"telephone_number": "252-636-4920",
"fax_number": "252-636-4970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2818 NEUSE BLVD",
"city": "NEW BERN",
"state": "NC",
"postal_code": "28562",
"telephone_number": "252-636-4920",
"fax_number": "252-636-4970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POOLE",
"first_name": "LISA",
"middle_name": "GRAY",
"name_prefix": "Mrs.",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "NC",
"license": "12177",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC PHARMACY BOARD",
"identifier": "ZM0000024",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC CNM",
"identifier": "383",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Bern, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.