Jaise Thekkan Poulose, M.D.

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

License

53941 Issued in KY

Practice address

1 Medical Village Dr
Edgewood, KY 41017-3403

Phone

(859) 757-2927

Fax

(859) 341-0203

NPI assigned

Mar 23, 2007

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 7

Medicare fee-for-service enrollment

Enrolled in KY

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

Critical Care (Intensivists)Also: Internal Medicine

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Elizabeth Edgewood Hospital, Edgewood, KY, CCN 180035
• St Elizabeth Florence Hospital, Florence, KY, CCN 180045

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Summit Medical Group, Inc

  • Family Medicine Physician
  • Erlanger, KY
  • NPI 1750343216
  Medicare reassignment Care Compare group NPD
• Jennie Stuart Medical Center Inc

  • General Acute Care Hospital
  • Hopkinsville, KY
  • NPI 1235139312

  Family Medicine

  Medicare reassignment NPD
• Jennie Stuart Medical Center Inc

  • Family Nurse Practitioner
  • Hopkinsville, KY
  • NPI 1790086767
  NPD
• Jennie Stuart Medical Center Inc

  • Rural Health Clinic/Center
  • Hopkinsville, KY
  • NPI 1912627605
  NPD
• Summit Medical Group, Inc.

  • Foot & Ankle Surgery Podiatrist
  • Crestview Hills, KY
  • NPI 1043188378
  NPD
• Summit Medical Group, Inc.

  • Urgent Care Clinic/Center
  • Highland Heights, KY
  • NPI 1881026169

  Family Medicine

  NPD
• Mayo Clinic

  • Clinical Medical Laboratory
  • Rochester, MN
  • NPI 1083249577
  NPD (past)

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

• St Elizabeth Medical Center, Inc

  • General Acute Care Hospital
  • Florence, KY
  • NPI 1154365062
  Care Compare affiliation
• St Elizabeth Medical Center, Inc

  • General Acute Care Hospital
  • Edgewood, KY
  • NPI 1467492421
  Care Compare affiliation

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1497872675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-757-2927",
            "fax_number": "859-341-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL VILLAGE DR",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173403",
            "telephone_number": "859-757-2927",
            "fax_number": "859-341-0203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 W 18th St",
            "address_purpose": "LOCATION",
            "city": "Hopkinsville",
            "state": "KY",
            "postal_code": "422401965",
            "country_code": "US",
            "telephone_number": "270-887-0100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POULOSE",
        "first_name": "JAISE",
        "middle_name": "THEKKAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "ND",
            "license": "11150",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MN",
            "license": "50104",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "LA",
            "license": "MD.207663",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "KY",
            "license": "53941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "913427000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10502",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N714361",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100672860",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35190900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debra Poe, RDH
• Olivia Pohlmann
• Robert J Polacek, MD
• Ashley Nicole Pope, APRN
• Rebecca Elise Popham, D.O.
• Shelby Rayne Powell, MS, BCBA, LBA
• Linda Poynter, R.D.H
• Suraj Prakash, M.D., M.B.A
• Steven H Press, ARNP
• Robert Lawrence Prichard Jr., MD

• Critical Care Medicine (Internal Medicine) Physician in Edgewood, KY
• Providers in Edgewood, KY by specialty
• Critical Care Medicine (Internal Medicine) Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.