NPIMap

Individual provider Active NPI

Jacob Adam Poore, CRNA

  • Certified Registered Nurse Anesthetist
  • Ft. Bliss, TX
National Provider Identifier
1598433245
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2024005892 Issued in MO
Practice address
18511 Highlander Medics Street
William Beaumont Army Medical Center
Ft. Bliss, TX 79918
Phone
(915) 569-3213
NPI assigned
Aug 30, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 134142 WA
Certified Registered Nurse Anesthetist 367500000X 2024005892 MO Primary

Addresses

Primary practice location

18511 Highlander Medics Street
William Beaumont Army Medical Center
Ft. Bliss, TX 79918

Mailing address

18511 Highlander Medics Street
Ft. Bliss, TX 79918
Phone (915) 569-3213

Other practice location 1

One Hospital Dr
Columbia, MO 65212-0001
Phone (573) 882-2568

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240815003132 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 3072051424 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carroll County Memorial HospitalGroup PAC ID 2860485638, 64 clinicians
John Fitzgibbon Memorial Hospital IncGroup PAC ID 2567351570, 45 clinicians

Practice addresses (Care Compare)

1502 N Jefferson St
Carrollton, MO 64633-1948
Phone (660) 542-1695

2305 S 65 Hwy
Marshall, MO 65340-3702

2305 S Hwy 65
Marshall, MO 65340-3702

Hospital & facility affiliations

  • Fitzgibbon Hospital Hospital, Marshall, MO, CCN 260142
  • Carroll County Memorial Hospital Hospital, Carrollton, MO, CCN 261332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2024005892MOMDCertified Registered Nurse Anesthetist
134142WAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Lukes Hospital of Chillicothe CurrentSince Oct 8, 2024 Accepting new patients
Saint Luke'S Hospital of Trenton CurrentSince Jul 1, 2025 Accepting new patients
John Fitzgibbon Memorial Hospital Inc. CurrentSince Jul 1, 2024 Accepting new patients
Saint Lukes Hospital of Chillicothe CurrentSince Jul 1, 2025 Accepting new patients
Saint Lukes Hospital of Chillicothe CurrentSince Oct 8, 2024 Accepting new patients
John Fitzgibbon Memorial Hospital Inc Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2024 Accepting new patients
John Fitzgibbon Memorial Hospital Inc Current Accepting new patients
Saint Luke'S Hospital of Trenton CurrentSince Jul 1, 2025 Accepting new patients

Locations

1502 N Jefferson St
Carrollton, MO 64633
Phone (660) 542-1695

2799 N Washington St
Chillicothe, MO 64601
Phone (660) 214-8300

2305 S Highway 65
Marshall, MO 65340
Phone (660) 831-3730

191 Iowa Blvd
Trenton, MO 64683
Phone (660) 358-5700

Interoperability endpoints

  • FHIR API: https://epicmobile.corp.saint-lukes.org/FHIRPROXY/api/FHIR/R4

Organizations & group practices 9

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1598433245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18511 HIGHLANDER MEDICS STREET",
            "city": "FT. BLISS",
            "state": "TX",
            "postal_code": "79918",
            "telephone_number": "915-569-3213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18511 HIGHLANDER MEDICS STREET",
            "address_2": "WILLIAM BEAUMONT ARMY MEDICAL CENTER",
            "city": "FT. BLISS",
            "state": "TX",
            "postal_code": "79918",
            "telephone_number": "915-569-3213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "One Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652120001",
            "country_code": "US",
            "telephone_number": "573-882-2568",
            "fax_number": "855-903-0985",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POORE",
        "first_name": "JACOB",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-30",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WA",
            "license": "134142",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2024005892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft. Bliss, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.