Individual provider Active NPI

George William Poulos, M.D., PH.D.

  • Diagnostic Radiology Physician
  • Brockton, MA
National Provider Identifier
1215109103
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
234627 Issued in MA
Practice address
680 Centre St
Signature Healthcare, Brockton Hospital, Radiology
Brockton, MA 02302-3308
Phone
(508) 941-7150
NPI assigned
Mar 31, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0101278879 VA
Diagnostic Radiology Physician 2085R0202X 234627 MA Primary

Addresses

Primary practice location

680 Centre St
Signature Healthcare, Brockton Hospital, Radiology
Brockton, MA 02302-3308

Mailing address

6 Navaho Dr
Canton, MA 02021-1261
Phone (781) 254-4226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080801000025 MA Practitioner - Diagnostic Radiology 4284708793 Reassigns benefits to 1 organization
I20240111000057 NC Practitioner - Diagnostic Radiology 4284708793

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Albert Einstein College of Medicine of Yeshiva University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Signature Healthcare Medical Group IncGroup PAC ID 7719876267, 250 clinicians

Practice addresses (Care Compare)

130 Quincy Ave
Brockton, MA 02302-2803
Phone (508) 941-7268

166 Quincy Ave
Brockton, MA 02302-2803
Phone (508) 587-5252

176 Quincy Ave
Brockton, MA 02302-2803
Phone (508) 941-7766

178 Quincy Ave
Brockton, MA 02302-2803
Phone (508) 586-7400

680 Centre St
Brockton, MA 02302-3308
Phone (508) 941-7000

Hospital & facility affiliations

  • Signature Healthcare Brockton Hospital Hospital, Brockton, MA, CCN 220052

Merit-based Incentive Payment System (MIPS)

Final score
93.16 of 100Reported as apm
Quality
83.58
Promoting interoperability
94
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.55 of 100Reported as group
Quality
100
Improvement activities
40
Cost
78.49

Merit-based Incentive Payment System (MIPS)

Final score
88.83 of 100Reported as group
Quality
70.13
Promoting interoperability
100
Improvement activities
40
Cost
75.97

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
234627MAMDDiagnostic Radiology Physician
0101278879VAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Healthcare Medical Group Inc CurrentSince Oct 1, 2013 Accepting new patients
Raleigh Radiology, LLC Diagnostic Radiology CurrentSince Nov 28, 2023 Accepting new patients
Raleigh Radiology Associates, Inc. Diagnostic Radiology CurrentSince Aug 1, 2023 Accepting new patients

Locations

110 Liberty St
Brockton, MA 02301

680 Centre St
Brockton, MA 02302
Phone (508) 941-7400

150 Parkway Office Ct
Ste 100
Cary, NC 27518

5220 Greens Dairy Rd
Raleigh, NC 27616
Phone (540) 493-4581

3200 Blue Ridge Rd
Ste 100
Raleigh, NC 27612
Phone (919) 256-3576

11640 Northpark Dr
Ste 110
Wake Forest, NC 27587

Interoperability endpoints

  • Direct secure messaging: george.poulos@direct.signature.masshiway.net

Organizations & group practices 3

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 1

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": "1206921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1215109103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 NAVAHO DR",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020211261",
            "telephone_number": "781-254-4226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 CENTRE ST",
            "address_2": "SIGNATURE HEALTHCARE, BROCKTON HOSPITAL, RADIOLOGY",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023023308",
            "telephone_number": "508-941-7150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULOS",
        "first_name": "GEORGE",
        "middle_name": "WILLIAM",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-31",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101278879",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "234627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.