Shawn Michael Poole, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

125.074978 Issued in IL

Practice address

701 N 1St St # D346
Springfield, IL 62702-3757

Phone

(217) 545-8444

Fax

(217) 545-2563

NPI assigned

Jun 18, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Vascular Surgery

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Surgical Professional Services LLCGroup PAC ID 8628253424, 367 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Hospital, Atlanta, GA, CCN 110161
• Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Northside Surgical Professional Services LLC

  • Surgery Physician
  • Atlanta, GA
  • NPI 1356630990
  Medicare reassignment Care Compare group NPD

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

• Northside Hospital, Inc.

  dba Northside Hospital Forsyth

  • General Acute Care Hospital
  • Cumming, GA
  • NPI 1376574277
  Care Compare affiliation
• Northside Hospital, Inc.

  dba Northside Hospital

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation

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

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1497315873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19638",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949638",
            "telephone_number": "217-545-8856",
            "fax_number": "217-545-2563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N 1ST ST # D346",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627023757",
            "telephone_number": "217-545-8444",
            "fax_number": "217-545-2563"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "980 Johnson Ferry Rd Ste 1040",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303421609",
            "country_code": "US",
            "telephone_number": "770-292-3490",
            "fax_number": "404-300-2317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POOLE",
        "first_name": "SHAWN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-18",
        "last_updated": "2024-07-22",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "GA",
            "license": "101054",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "125.074978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Lipson Pollock, PH.D.
• Linda Ponce Rosas, MD
• Jonathan Dean Ponser, M.A., LCPC, NCC
• Rama Poola, MD
• Venkateswara P Poola, MBBS
• Angelina Maria Pop, LPTA
• Dena L. Pope, APRN
• Starlit Pope
• Maryna J Popp, D.O.
• Dawn Michelle Porter, MD

• Vascular Surgery Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Vascular Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.