Individual provider Active NPI

Benjamin Kuttikatt Poulose, MD

  • Surgery Physician
  • Columbus, OH
National Provider Identifier
1194872986
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
35089610 Issued in OH
Practice address
1800 Zollinger Rd
Columbus, OH 43221-2849
Phone
(614) 293-3230
Fax
(614) 293-4030
NPI assigned
Jan 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 35089610 OH Primary

Addresses

Primary practice location

1800 Zollinger Rd
Columbus, OH 43221-2849

Mailing address

700 Ackerman Rd Ste 2120
Columbus, OH 43202-1559
Phone (614) 293-3230

Other identifiers 1

IdentifierTypeStateIssuer
0302346MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bpoulose643258@direct.osumc.edu

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180810002215 OH Practitioner - General Surgery 1254403025 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Johns Hopkins University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osu Surgery, LLCGroup PAC ID 0941105266, 207 clinicians
Oxford Physical Therapy and RehabilitationGroup PAC ID 0244232874, 432 clinicians

Practice addresses (Care Compare)

2050 Kenny Rd
Columbus, OH 43221-3502
Phone (614) 366-6675

7567 Central Parke Blvd
Mason, OH 45040-6852

Hospital & facility affiliations

  • Ohio State University State Health System Hospital, Columbus, OH, CCN 360085
  • James Cancer Hospital & Solove Research Institute Hospital, Columbus, OH, CCN 360242

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)23
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35089610OHMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osu Surgery, LLC Surgery CurrentSince Jun 20, 2018 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Ohio State University Hospitals Past Accepting new patients

Locations

2050 Kenny Rd
Columbus, OH 43221
Phone (614) 293-8054

300 W 10th Ave
Fl 4
Columbus, OH 43210
Phone (614) 293-8074

700 Ackerman Rd
Ste 570
Columbus, OH 43202
Phone (614) 293-2046

700 Ackerman Rd
Ste 2120
Columbus, OH 43202

1800 Zollinger Rd
Upper Arlington, OH 43221
Phone (614) 293-2130

1800 Zollinger Rd
Fl 3
Upper Arlington, OH 43221
Phone (614) 293-2130

Interoperability endpoints

  • Direct secure messaging: bpoulose643258@direct.osumc.edu

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612483200000",
    "number": "1194872986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 ACKERMAN RD STE 2120",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432021559",
            "telephone_number": "614-293-3230",
            "fax_number": "614-293-4030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 ZOLLINGER RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432212849",
            "telephone_number": "614-293-3230",
            "fax_number": "614-293-4030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULOSE",
        "first_name": "BENJAMIN",
        "middle_name": "KUTTIKATT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35089610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0302346",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bpoulose643258@direct.osumc.edu",
            "affiliation": "N",
            "address_1": "1800 Zollinger Rd",
            "city": "Columbus",
            "state": "OH",
            "country_code": "US",
            "postal_code": "432212849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.