Mickoyan Nakita Poole, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15766 Issued in CA

Practice address

425 E Foothill Blvd
Rialto, CA 92376-5153

Phone

(909) 546-1005

Fax

(909) 546-1061

NPI assigned

Jun 29, 2012

Sex

Male

Sole proprietor

Yes

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 CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mickoyan.poole.p1@direct.metro.nextgenshare.com

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.

• American Current Care of California, a Medical Corporation

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1750573622
  Medicare reassignment
• Raincross Urgent Care, Inc.

  • Urgent Care Clinic/Center
  • Riverside, CA
  • NPI 1932615077
  Medicare reassignment
• San Marcos Medical Group Inc

  • Obstetrics & Gynecology Physician
  • Fontana, CA
  • NPI 1447446448
  Medicare reassignment
• American Current Care of California, a Medical Corporation

  • Urgent Care Clinic/Center
  • San Francisco, CA
  • NPI 1932491685

  Multi-Specialty

  NPD

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644192000000",
    "number": "1316201734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 E FOOTHILL BLVD",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923765153",
            "telephone_number": "909-546-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 E FOOTHILL BLVD",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923765153",
            "telephone_number": "909-546-1005",
            "fax_number": "909-546-1061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "MICKOYAN",
        "middle_name": "NAKITA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-29",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "15766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316201734",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryl Placide, MFT
• Emily Darline Plata
• Christina M Poffenberger, BS
• Vickye Lynn Poindexter-Wilson
• Patricia A Pompa, D.D.S.
• Liliana Popova, DDS
• Melanie Lee Porges
• Arsalan Pourteymour, M.D.
• Elizabeth Concepcion Powell
• Prabhjot Singh Ahuja

• Physician Assistant in Rialto, CA
• Providers in Rialto, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.