Kathryn Marie Poulos

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601006317 Issued in MI

Practice address

9377 N Haggerty Rd
Plymouth, MI 48170

Phone

(734) 451-0070

Fax

(734) 451-1583

NPI assigned

Mar 5, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Park Family Health Care PCGroup PAC ID 9638077621, 20 clinicians

Ross Summers MD PLLCGroup PAC ID 9830099563, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Park Family Health Care, P.C.

  • Family Medicine Physician
  • Detroit, MI
  • NPI 1437161437
  Medicare reassignment Care Compare group
• Ross Summers MD PLLC

  dba Medical Clinic of Northville

  • Family Medicine Physician
  • Northville, MI
  • NPI 1295865954
  Medicare reassignment Care Compare group
• Elliott I. Greenspan, D.O., P.C. & Associates

  • Internal Medicine Physician
  • Farmington Hills, MI
  • NPI 1063577641
  Medicare reassignment

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

{
    "created_epoch": "1330905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1083988323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9377 N HAGGERTY RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481704622",
            "telephone_number": "734-451-0070",
            "fax_number": "734-451-1583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9377 N HAGGERTY RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "48170",
            "telephone_number": "734-451-0070",
            "fax_number": "734-451-1583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22301 Kelly Rd",
            "address_purpose": "LOCATION",
            "city": "Eastpointe",
            "state": "MI",
            "postal_code": "480212619",
            "country_code": "US",
            "telephone_number": "586-443-5588",
            "fax_number": "586-443-5538",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POULOS",
        "first_name": "KATHRYN",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-05",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "5601006317",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trent Poquette
• Arianna Porter
• Sydney Porter, CNIM, R.EEG/EP T.
• Alyssa Potter
• Michele Rocheleau Potter, LMSW
• Aniyah Pouncy
• Jenna Powe
• Aikima Powers
• Alexandra Powers
• Lauren Powers

• Physician Assistant in Plymouth, MI
• Providers in Plymouth, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.