Jasmine Shareen Agyei-Poku, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Chicago, IL
NPI 1013764182 · NPPES record last updated Aug 5, 2024
Key facts
- NPI
- 1013764182
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 2233 W Division St
Chicago, IL 60622-8151 - Phone
- (312) 770-2858
- NPI assigned
- May 6, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240716000390 | IL | Order and Referring Only - Family Practice |
7719422674 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Interoperability endpoints
- jasmine.coles.1@16494.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
2233 W Division St
Chicago, IL 60622-8151
Mailing address
2233 W Division St
Chicago, IL 60622-8151
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.