Active NPI
Jill Ann Pool, PA-C
- Physician Assistant
- Riverton, KS
National Provider Identifier
1497934731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 15-01209
- Practice address
- 6610 SE Quakervale Rd
Riverton, KS 66770-4185 - Phone
- (620) 848-2300
- Fax
- (620) 848-2301
- NPI assigned
- Nov 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 15-01209 | KS | Primary |
Addresses
Primary practice location
6610 SE Quakervale Rd
Riverton, KS 66770-4185
Mailing address
6610 SE Quakervale Rd
Riverton, KS 66770-4185
Phone (620) 848-2300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200535880C | Medicaid | KS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071227000208 | KS | Practitioner - Physician Assistant | 4082704374 | Reassigns benefits to 2 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15-01209 | KS | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Hospital Columbus | Current | Accepting new patients |
Locations
220 N Pennsylvania Ave
Columbus, KS 66725
Phone (620) 429-2545
Interoperability endpoints
- jpool384552@directb.mercy.net
- jpool394220@directc.mercy.net
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384300800000",
"number": "1497934731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6610 SE QUAKERVALE RD",
"city": "RIVERTON",
"state": "KS",
"postal_code": "667704185",
"telephone_number": "620-848-2300",
"fax_number": "620-848-2301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6610 SE QUAKERVALE RD",
"city": "RIVERTON",
"state": "KS",
"postal_code": "667704185",
"telephone_number": "620-848-2300",
"fax_number": "620-848-2301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POOL",
"first_name": "JILL",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-02",
"last_updated": "2013-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "KS",
"license": "15-01209",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200535880C",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverton, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; 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.