Nickolas Evangelos Poulos, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

DR.0059273 Issued in CO

Practice address

711 N Taylor St
Gunnison, CO 81230-2208

Phone

(970) 641-9482

Fax

(970) 642-4798

NPI assigned

Jun 28, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Dermatology

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gunnison Valley HospitalGroup PAC ID 8426040486, 81 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Gunnison Valley Hospital Hospital, Gunnison, CO, CCN 061320
• Montrose Regional Health Hospital, Montrose, CO, CCN 060006

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nickolas.poulos.1@11629.direct.athenahealth.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.

• Gunnison Valley Hospital

  • Critical Access Hospital
  • Gunnison, CO
  • NPI 1932109048
  Medicare reassignment Care Compare group NPD
• Global Dermatology, Inc.

  • Dermatology Physician
  • Gunnison, CO
  • NPI 1134698103
  NPD Authorized official
• Gunnison Valley Hospital

  • Urgent Care Clinic/Center
  • Gunnison, CO
  • NPI 1477361228
  NPD
• Gunnison Valley Hospital

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gunnison, CO
  • NPI 1518735711
  NPD
• Gunnison Valley Hospital

  • Primary Care Clinic/Center
  • Gunnison, CO
  • NPI 1578997284
  NPD

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

• Gunnison Valley Hospital

  • Urgent Care Clinic/Center
  • Crested Butte, CO
  • NPI 1134754153

  Hospital

  Care Compare affiliation
• Gunnison Valley Hospital

  • Critical Access Hospital
  • Gunnison, CO
  • NPI 1932109048
  Care Compare affiliation
• Montrose Memorial Hospital, Inc

  • General Acute Care Hospital
  • Montrose, CO
  • NPI 1205822186
  Care Compare affiliation

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

{
    "created_epoch": "1403913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749600000000",
    "number": "1457766487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 N TAYLOR ST",
            "city": "GUNNISON",
            "state": "CO",
            "postal_code": "812302208",
            "telephone_number": "970-641-3927",
            "fax_number": "970-642-4798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 N TAYLOR ST",
            "city": "GUNNISON",
            "state": "CO",
            "postal_code": "812302208",
            "telephone_number": "970-641-9482",
            "fax_number": "970-642-4798"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Cochrane Cir Bldg 75001",
            "address_purpose": "LOCATION",
            "city": "Fort Carson",
            "state": "CO",
            "postal_code": "809134613",
            "country_code": "US",
            "telephone_number": "719-526-7185",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6140 SW 70th St Fl 2",
            "address_purpose": "LOCATION",
            "city": "South Miami",
            "state": "FL",
            "postal_code": "331433419",
            "country_code": "US",
            "telephone_number": "305-284-7524",
            "fax_number": "719-960-3111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10350 E Dakota Ave",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802471314",
            "country_code": "US",
            "telephone_number": "303-338-4545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POULOS",
        "first_name": "NICKOLAS",
        "middle_name": "EVANGELOS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-28",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS13474",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CO",
            "license": "DR.0059273",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "OS13474",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": "DR.0059273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000176165",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER COMMERCIAL NUMBER",
            "identifier": "029298",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10350 E Dakota Ave",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802471314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Stacy Rae, L.AC.
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• Sherry Rice

• Dermatology Physician in Gunnison, CO
• Providers in Gunnison, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; 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.