Individual provider Active NPI

Jennifer Poe, NP

  • Adult Health Nurse Practitioner
  • San Luis Obispo, CA
National Provider Identifier
1073157426
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
95012566 Issued in CA
Practice address
1250 Peach St Ste B
San Luis Obispo, CA 93401
Phone
(805) 543-4043
Fax
(805) 543-7640
NPI assigned
Oct 29, 2019
Last updated
Jul 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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 95012566 CA Primary

Addresses

Primary practice location

1250 Peach St Ste B
San Luis Obispo, CA 93401

Mailing address

1250 Peach St Ste B
San Luis Obispo, CA 93401-2869
Phone (805) 543-4043

Other practice location 1

235 S Palisade Dr
Santa Maria, CA 93454
Phone (805) 739-3561

Other practice location 2

1250 Peach St Ste A
San Luis Obispo, CA 93401
Phone (805) 543-4043

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20200113000693 CA Practitioner - Nurse Practitioner 1456786839 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1250 Peach St
Suite B
San Luis Obispo, CA 93401-2869
Phone (805) 543-4043

1510 E Main St
Suite 104 C
Santa Maria, CA 93454-4825
Phone (805) 349-8514

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.64 of 100Reported as apm
Quality
86.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95012566CAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Central Coast Health Centers Current Accepting new patients
Pacific Central Coast Health Centers CurrentSince Jan 5, 2020 Accepting new patients
Pacific Central Coast Health Centers CurrentSince Jan 5, 2020 Accepting new patients
Pacific Central Coast Health Centers Past Accepting new patients
Pacific Central Coast Health Centers Past Accepting new patients

Locations

117 W Bunny Ave
Santa Maria, CA 93458
Phone (805) 739-3474

1400 E Church St
Bldg 8
Santa Maria, CA 93454
Phone (800) 739-3561

1400 E Church St
Ofc
Santa Maria, CA 93454
Phone (805) 739-3112

1414 E Main St
Ste 201
Santa Maria, CA 93454
Phone (805) 739-3112

1510 E Main St
Ste 104C
Santa Maria, CA 93454
Phone (805) 349-8514

235 S Palisade Dr
Santa Maria, CA 93454
Phone (805) 739-3561

1250 Peach St
Ste A
Sn Luis Obisp, CA 93401
Phone (805) 543-4043

1250 Peach St
Ste B
Sn Luis Obisp, CA 93401
Phone (805) 543-4043

Organizations & group practices 5

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": "1572307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1073157426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 PEACH ST STE B",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012869",
            "telephone_number": "805-543-4043",
            "fax_number": "805-543-7640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 PEACH ST STE B",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "93401",
            "telephone_number": "805-543-4043",
            "fax_number": "805-543-7640"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "235 S Palisade Dr",
            "address_purpose": "LOCATION",
            "city": "Santa Maria",
            "state": "CA",
            "postal_code": "93454",
            "country_code": "US",
            "telephone_number": "805-739-3561",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1250 Peach St Ste A",
            "address_purpose": "LOCATION",
            "city": "San Luis Obispo",
            "state": "CA",
            "postal_code": "93401",
            "country_code": "US",
            "telephone_number": "805-543-4043",
            "fax_number": "805-543-7640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POE",
        "first_name": "JENNIFER",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-29",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "95012566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.