Active NPI
Panagiotis Paulus, M.D.
- Ophthalmology Physician
- Poplar Bluff, MO
National Provider Identifier
1578533030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- R6D36
- Practice address
- 2210 Barron Rd
Suite 114
Poplar Bluff, MO 63901-1908 - Phone
- (573) 686-4800
- Fax
- (573) 686-8448
- NPI assigned
- Jan 25, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | R6D36 | MO | Primary |
Addresses
Primary practice location
2210 Barron Rd
Suite 114
Poplar Bluff, MO 63901-1908
Mailing address
2210 Barron Rd
Suite 114
Poplar Bluff, MO 63901-1908
Phone (573) 686-4800
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180034174 | Other | MO | MEDICARE RAILROAD |
| 123992 | Other | BLUE CROSS BLUE SHIELD | |
| 203225719 | Medicaid | MO |
Other names 1
- Peter Paulus
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100312000787 | MO | Practitioner - Ophthalmology | 3274668496 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1578533030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2210 BARRON RD",
"address_2": "SUITE 114",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639011908",
"telephone_number": "573-686-4800",
"fax_number": "573-686-8448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2210 BARRON RD",
"address_2": "SUITE 114",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639011908",
"telephone_number": "573-686-4800",
"fax_number": "573-686-8448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAULUS",
"first_name": "PANAGIOTIS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-25",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MO",
"license": "R6D36",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "180034174",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "123992",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "203225719",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PETER",
"last_name": "PAULUS",
"credential": "M.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.