Individual provider Active NPI

Megan Michelle Poole, PA-C

  • Physician Assistant
  • Mishawaka, IN
National Provider Identifier
1053201590
Registry record updated Nov 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10004964A Issued in IN
Practice address
5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469
Phone
(574) 335-5000
NPI assigned
Jul 7, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10004964A IN Primary

Addresses

Primary practice location

5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469

Mailing address

5812 Iroquois LN Apt 1a
Mishawaka, IN 46545-0908

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250903000210 IN Practitioner - Physician Assistant 0749781482 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1601 Cummins Dr
Suite D
Modesto, CA 95358-6403

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America LLC CurrentSince Aug 25, 2025 Accepting new patients
Cep America LLC CurrentSince Aug 25, 2025 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1751846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762992000000",
    "number": "1053201590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5812 IROQUOIS LN APT 1A",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465450908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 HOLY CROSS PKWY",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451469",
            "telephone_number": "574-335-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "MEGAN",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-07",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10004964A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.