NPIMap

Individual provider Active NPI

Jeffrey S Poole, MD

  • Gastroenterology Physician
  • Ogden, UT
National Provider Identifier
1649266776
Registry record updated Sep 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
5285827-1205 Issued in UT
Practice address
6028 S Ridgeline Dr
Suite 201
Ogden, UT 84405-6914
Phone
(801) 475-5400
Fax
(801) 475-8614
NPI assigned
Sep 23, 2005
Last updated
Sep 23, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 5285827-1205 UT Primary

Addresses

Primary practice location

6028 S Ridgeline Dr
Suite 201
Ogden, UT 84405-6914

Mailing address

6028 S Ridgeline Dr
Suite 201
Ogden, UT 84405-6914
Phone (801) 475-5400

Other identifiers 2

IdentifierTypeStateIssuer
870653164002MedicaidUT
107018375101OtherUTIHC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20060119000853 UT Practitioner - Gastroenterology 3274557004 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of Toledo College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tanner Memorial ClinicGroup PAC ID 4284547985, 251 clinicians

Practice addresses (Care Compare)

2121 N 1700
Layton, UT 84041-8803
Phone (801) 773-4840

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy254
Upper gastrointestinal (GI) endoscopy for acid reflux497

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5285827-1205UTMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Memorial Clinic CurrentSince Aug 1, 2018 Accepting new patients
Tanner Memorial Clinic CurrentSince Aug 1, 2018 Accepting new patients
Rosenberg Cooley Metcalf LC Past Accepting new patients

Locations

2132 N Robins Dr
Layton, UT 84041
Phone (801) 479-5642

2132 N Robins Dr
Ste 310
Layton, UT 84041

6028 S Ridgeline Dr
Ste 201
South Ogden, UT 84405
Phone (801) 475-5400

Interoperability endpoints

  • Direct secure messaging: jeffrey.poole.p1@direct.tannerclinic.nextgenshare.com

Organizations & group practices 3

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 4

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": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285200000000",
    "number": "1649266776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6028 S RIDGELINE DR",
            "address_2": "SUITE 201",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844056914",
            "telephone_number": "801-475-5400",
            "fax_number": "801-475-8614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6028 S RIDGELINE DR",
            "address_2": "SUITE 201",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844056914",
            "telephone_number": "801-475-5400",
            "fax_number": "801-475-8614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "JEFFREY",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2010-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "UT",
            "license": "5285827-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870653164002",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107018375101",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

Verify at the official NPI Registry.