NPIMap

Individual provider Active NPI

Jacob Poulose, MD.

  • Nephrology Physician
  • Northridge, CA
National Provider Identifier
1578723508
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A113557 Issued in CA
Practice address
8349 Reseda Blvd Ste G
Northridge, CA 91324-5914
Phone
(818) 886-5827
Fax
(818) 775-9351
NPI assigned
Jun 12, 2008
Last updated
Jan 11, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A113557 CA
Nephrology Physician 207RN0300X A113557 CA Primary

Addresses

Primary practice location

8349 Reseda Blvd Ste G
Northridge, CA 91324-5914

Mailing address

8349 Reseda Blvd Ste G
Northridge, CA 91324-5914
Phone (818) 886-5828

Other identifiers 1

IdentifierTypeStateIssuer
00A1135570MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20101203000796 CA Practitioner - Internal MedicinePractitioner - Nephrology 5496942377 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
PaprGroup PAC ID 5092239061, 2 clinicians

Practice addresses (Care Compare)

8349 Reseda Blvd
Suite G
Northridge, CA 91324-5914
Phone (818) 886-7300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
113557CAMDMental Health Counselor
A113557CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Papr Nephrology CurrentSince Feb 1, 2025 Accepting new patients
Deanco Healthcare LLC. Past Accepting new patients
West Hills Hospital Past Accepting new patients
Simi Valley Hospital and Health Care Services Past Accepting new patients
Dignity Community Care Past Accepting new patients
Providence Health System - Southern California Past Accepting new patients
Valley Presbyterian Hospital Past Accepting new patients
Henry Mayo Newhall Memorial Hospital Past Accepting new patients

Locations

8349 Reseda Blvd
Ste G
Northridge, CA 91324
Phone (818) 886-7300

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1578723508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8349 RESEDA BLVD STE G",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913245914",
            "telephone_number": "818-886-5828",
            "fax_number": "818-775-9351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8349 RESEDA BLVD STE G",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913245914",
            "telephone_number": "818-886-5827",
            "fax_number": "818-775-9351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULOSE",
        "first_name": "JACOB",
        "credential": "MD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-12",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A113557",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A113557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A1135570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, CA

Sources for this page

Verify at the official NPI Registry.