NPIMap

Individual provider Active NPI

Jeremy W Poole, D.O.

  • Family Medicine Physician
  • Thomasville, GA
National Provider Identifier
1548343593
Registry record updated Mar 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
033433 Issued in GA
Practice address
951 S Broad St
Thomasville, GA 31792-6161
Phone
(229) 228-4130
Fax
(229) 226-4690
NPI assigned
Oct 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 033433 GA Primary

Addresses

Primary practice location

951 S Broad St
Thomasville, GA 31792-6161

Mailing address

951 S Broad St
Thomasville, GA 31792-6161
Phone (229) 228-4130

Other identifiers 5

IdentifierTypeStateIssuer
024957OtherGABCBS PROVIDER NUMBER
11DO266342OtherGACLIA LAB PROVIDER NUMBER
728528012CMedicaidGA
GRP1474OtherGAMEDICARE GROUP NUMBER
0001417567 10OtherGAUNITED HEALTHCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060315000671 GA Practitioner - Family Practice 0143278192 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

101 Yorktown Dr
Fayetteville, GA 30214-1578

101 Yorktown Dr
Suite 100
Fayetteville, GA 30214-7663
Phone (770) 460-4285

2600 Compass Rd
Glenview, IL 60026-8001

951 S Broad St
Thomasville, GA 31792-6161
Phone (229) 228-4130

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Pines Community Service Board CurrentSince Jan 4, 2008 Accepting new patients
Privia Medical Group of Georgia LLC Family Medicine CurrentSince Dec 18, 2016 Accepting new patients
Pathology Associates, P.C. Current Accepting new patients
South Georgia Emergency Medicine Associates PC CurrentSince Jul 1, 2012 Accepting new patients
Privia Medical Group of Georgia LLC Family Medicine CurrentSince Dec 18, 2016 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Community Care Physicians, PC Family Medicine PastSince Jan 1, 1998 Accepting new patients

Locations

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

951 S Broad St
Thomasville, GA 31792
Phone (229) 228-4130

1102 Smith Ave
Ste K
Thomasville, GA 31792
Phone (912) 227-5468

1102 Smith Ave
Ste H
Thomasville, GA 31792
Phone (229) 225-5208

915 Gordon Ave
Thomasville, GA 31792
Phone (229) 228-8575

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jeremy.poole.1@8042.direct.athenahealth.com

Organizations & group practices 8

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269302400000",
    "number": "1548343593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 S BROAD ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926161",
            "telephone_number": "229-228-4130",
            "fax_number": "229-226-4690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 S BROAD ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926161",
            "telephone_number": "229-228-4130",
            "fax_number": "229-226-4690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "JEREMY",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2010-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "033433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "024957",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA LAB PROVIDER NUMBER",
            "identifier": "11DO266342",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "728528012C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "GRP1474",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0001417567 10",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thomasville, GA

Sources for this page

Verify at the official NPI Registry.