Tara D Poole, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PENDING Issued in MO

Practice address

1602 N 2ND St
Clinton, MO 64735-1192

Phone

(660) 885-8171

NPI assigned

Dec 17, 2024

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

Medicare fee-for-service enrollment

Enrolled in MO

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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Golden Valley Memorial Hospital DistrictGroup PAC ID 4688561814, 138 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Golden Valley Memorial Hospital Hospital, Clinton, MO, CCN 260175

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Golden Valley Memorial Hospital District

  • Rural Health Clinic/Center
  • Clinton, MO
  • NPI 1003873266
  Medicare reassignment Care Compare group NPD
• Golden Valley Memorial Hospital District

  • Clinic/Center
  • Clinton, MO
  • NPI 1396379830
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Golden Valley Memorial Hospital District

  • General Acute Care Hospital
  • Clinton, MO
  • NPI 1710075361
  Care Compare affiliation

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

{
    "created_epoch": "1734393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1265249858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-885-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-885-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "TARA",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-17",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Michael Peters, DDS
• Physicians Reference Laboratory LLC
• Daryl Pinedo, MD
• Shayla Michelle Pipes, RDH
• Mariana Politte, MA, LPC, NCC
• Courtney Louise Porter, M.S. CF-SLP
• Mallory Pritzel, M.S. CF-SLP
• Provcare Home Care Agency LLC
• Quad States Medical Rehab and Supply LLC
• Terri Rager-White, MS

• Physician Assistant in Clinton, MO
• Providers in Clinton, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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.