NPIMap

Individual provider Active NPI

Kenneth George Poole Jr., M.D.

  • Internal Medicine Physician
  • Rochester, MN
National Provider Identifier
1649434408
Registry record updated Dec 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
72328 Issued in MN
Practice address
200 1St St SW
Rochester, MN 55905-0001
Phone
(507) 284-2511
NPI assigned
Jul 10, 2008
Last updated
Dec 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2010022098 MO
Internal Medicine Physician 207R00000X 72328 MN Primary
Internal Medicine Physician 207R00000X 48643 AZ

Addresses

Primary practice location

200 1St St SW
Rochester, MN 55905-0001

Mailing address

8170 33Rd Ave S # Ms 21110Q
Bloomington, MN 55425-4516

Other practice location 1

9555 Upland Ln N
Maple Grove, MN 55369-4485
Phone (952) 993-1440

Other practice location 2

13400 E Shea Blvd
Scottsdale, AZ 85259
Phone (480) 301-8000

Other practice location 3

13400 E Shea Blvd
Scottsdale, AZ 85259
Phone (480) 301-8000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kpoole389512@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20220914001193 MN Practitioner - Internal Medicine 3678741139 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians
Mayo ClinicGroup PAC ID 6507778255, 4,829 clinicians

Practice addresses (Care Compare)

15800 95TH Ave N
Maple Grove, MN 55369-4400
Phone (952) 993-1440

200 1St St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Family Medicine CurrentSince Jan 5, 2026 Accepting new patients
Mayo Clinic CurrentSince Aug 31, 2022 Accepting new patients
Park Nicollet Clinic Family Medicine CurrentSince Jan 5, 2026 Accepting new patients
Mayo Clinic CurrentSince Aug 31, 2022 Accepting new patients
Terros Inc PastSince Aug 20, 2020 Accepting new patients
Mayo Clinic Past Accepting new patients

Locations

13400 E Shea Blvd
Scottsdale, AZ 85259

9555 Upland Ln N
Maple Grove, MN 55369
Phone (952) 993-1440

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

Ownership & related parties

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Terros, Inc.Glendale, AZ, CCN 031923 Federally qualified health center Corporate Director Aug 20, 2020
Terros HealthPhoenix, AZ, CCN 031934 Federally qualified health center Corporate Director Jan 25, 2020
Terros, Inc - FQHC McDowell RdPhoenix, AZ, CCN 031960 Federally qualified health center Corporate Director Jan 25, 2020
Terros HealthMesa, AZ, CCN 031000 Federally qualified health center Corporate Director Jan 25, 2020
TerroshealthPhoenix, AZ, CCN 031031 Federally qualified health center Corporate Director Aug 20, 2020
Terros, Inc.Tempe, AZ, CCN 031032 Federally qualified health center Corporate Director Aug 20, 2020
Terros HealthPhoenix, AZ, CCN 031033 Federally qualified health center Corporate Director Jan 21, 2020
Terros, Inc.Mesa, AZ, CCN 031038 Federally qualified health center Corporate Director Jan 21, 2020
Terros, Inc.Phoenix, AZ, CCN 031044 Federally qualified health center Corporate Director Jan 21, 2020
Terros, Inc.Mesa, AZ, CCN 031043 Federally qualified health center Corporate Director Aug 20, 2020
Terros, Inc.Phoenix, AZ, CCN 031045 Federally qualified health center Corporate Director Aug 20, 2020
Terros HealthPhoenix, AZ, CCN 031051 Federally qualified health center Corporate Director Aug 20, 2020
Terros HealthPhoenix, AZ, CCN 031048 Federally qualified health center Corporate Director Aug 20, 2020
Terros, Inc.Glendale, AZ, CCN 031058 Federally qualified health center Corporate Director Jan 25, 2020

Owned or controlled facilities with NPI records 14

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 14

Organizations & group practices 7

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 7

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": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766361600000",
    "number": "1649434408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "507-284-2511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9555 Upland Ln N",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553694485",
            "country_code": "US",
            "telephone_number": "952-993-1440",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13400 E Shea Blvd",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "85259",
            "country_code": "US",
            "telephone_number": "480-301-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13400 E Shea Blvd",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "85259",
            "country_code": "US",
            "telephone_number": "480-301-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POOLE",
        "first_name": "KENNETH",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-10",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2010022098",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "72328",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "48643",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpoole389512@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "200 1st St SW",
            "city": "Rochester",
            "state": "MN",
            "country_code": "US",
            "postal_code": "559050001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.