Active NPI
Stephen Joseph Poor III, MD
- Ophthalmology Physician
- Chelmsford, MA
National Provider Identifier
1144209685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 31356
- Practice address
- 17 Village SQ
Chelmsford, MA 01824-2712 - Phone
- (978) 250-8001
- Fax
- (978) 250-4142
- NPI assigned
- Jan 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 31356 | MA | Primary |
Addresses
Primary practice location
17 Village SQ
Chelmsford, MA 01824-2712
Mailing address
1 Edward St
Canton, MA 02021-2303
Phone (781) 828-3533
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15280 | Other | MA | PILGRIM HEALTH |
| 35076 | Other | MA | DAVIS VISION |
| 700580 | Other | MA | TUFTS HEALTH |
| 0152471 | Medicaid | MA | |
| STC16060 | Other | MA | BLUE CROSS & BLUE SHIELD |
| 0082752 | Other | MA | U.S.HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144209685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 EDWARD ST",
"city": "CANTON",
"state": "MA",
"postal_code": "020212303",
"telephone_number": "781-828-3533",
"fax_number": "781-828-2471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 VILLAGE SQ",
"city": "CHELMSFORD",
"state": "MA",
"postal_code": "018242712",
"telephone_number": "978-250-8001",
"fax_number": "978-250-4142"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POOR",
"first_name": "STEPHEN",
"middle_name": "JOSEPH",
"name_suffix": "III",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MA",
"license": "31356",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PILGRIM HEALTH",
"identifier": "15280",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAVIS VISION",
"identifier": "35076",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH",
"identifier": "700580",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0152471",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "STC16060",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U.S.HEALTH",
"identifier": "0082752",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chelmsford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.