NPIMap

Individual provider Active NPI

Michele Lynn Poulos, RN, MSN, ANP-C

  • Adult Health Nurse Practitioner
  • Sandusky, OH
National Provider Identifier
1053484287
Registry record updated Sep 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
01143NP Issued in OH
Practice address
2500 W Strub Rd
Suite 230
Sandusky, OH 44870-5390
Phone
(419) 626-6891
Fax
(419) 626-8009
NPI assigned
Nov 16, 2006
Last updated
Sep 16, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 01143NP OH Primary

Addresses

Primary practice location

2500 W Strub Rd
Suite 230
Sandusky, OH 44870-5390

Mailing address

PO Box 378
Sandusky, OH 44871-0378
Phone (419) 609-1112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100129000464 OH Practitioner - Nurse Practitioner 8224171236 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2500 W Strub Rd
Suite 230
Sandusky, OH 44870-5390
Phone (419) 626-6161

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
01143NPOHMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Ohio Medical Specialists LLC CurrentSince Dec 12, 2009 Accepting new patients
Northern Ohio Medical Specialists, LLC CurrentSince Dec 12, 2009 Accepting new patients
North Ohio Heart Center Inc Adult Health Past Accepting new patients
Northern Ohio Medical Specialists, LLC Past Accepting new patients

Locations

2500 W Strub Rd
Ste 230
Sandusky, OH 44870
Phone (419) 625-1200

3004 Hayes Ave
Sandusky, OH 44870
Phone (419) 625-2841

Interoperability endpoints

  • Direct secure messaging: mpoulos20643@nomshealthcare.direct-ci.com

Organizations & group practices 4

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 8

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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410825600000",
    "number": "1053484287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 378",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448710378",
            "telephone_number": "419-609-1112",
            "fax_number": "419-609-1123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W STRUB RD",
            "address_2": "SUITE 230",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448705390",
            "telephone_number": "419-626-6891",
            "fax_number": "419-626-8009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULOS",
        "first_name": "MICHELE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "RN, MSN, ANP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2014-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "01143NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandusky, OH

Sources for this page

Verify at the official NPI Registry.