Stacia Poole, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME51873 Issued in FL

Practice address

930S Harbor City Blvd 101
Melbourne, FL 32901-1901

Phone

(321) 752-1599

Fax

(321) 956-9907

NPI assigned

Mar 1, 2006

Last updated

Dec 29, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Osler Medical Inc

  • Multi-Specialty Clinic/Center
  • Melbourne, FL
  • NPI 1356308670
  NPD (past)

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451347200000",
    "number": "1598732471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 S HARBOR CITY BLVD STE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011901",
            "telephone_number": "321-752-1599",
            "fax_number": "321-956-9907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930S HARBOR CITY BLVD 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011901",
            "telephone_number": "321-752-1599",
            "fax_number": "321-956-9907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "STACIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-01",
        "last_updated": "2015-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME51873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373042500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "070007530",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raymond Lyle Pollock, DDS
• Esther Pollok, MD
• Meagan Anne Pomerleau, ARNP
• Sheila Ponce, PSYD
• Gaston M Ponte Jr., M.D.
• Darlene Go Popat, M.D.
• Jessica R Pope, SLP
• Karen S Popovich, OT, CHT
• Floro Porciuncula, MD
• Porter Premier Dermatology and Surgery Center, PLLC

• Dermatology Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.