Jerry Matthew Poole, D.P.M.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

886-25 Issued in WI

Practice address

40 Skokie Blvd Ste 520
Northbrook, IL 60062-1601

Phone

(847) 504-5000

Fax

(847) 504-5015

NPI assigned

Feb 21, 2006

Sex

Male

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 3

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mobile Foot Doctors, Inc,

  • Foot & Ankle Surgery Podiatrist
  • Rolling Meadows, IL
  • NPI 1912276684
  Medicare reassignment NPD
• Preferred Podiatry Group PC

  • Podiatrist
  • Oak Harbor, WA
  • NPI 1720037138

  IL

  Medicare reassignment
• Illinois Institute of Foot and Ankle, P.C.

  • Foot & Ankle Surgery Podiatrist
  • Rolling Meadows, IL
  • NPI 1831497668
  NPD
• Asg Onsite Podiatry of Ia 1 PC

  • Podiatrist
  • Chicago, IL
  • NPI 1598016503
  NPD (past)

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548115200000",
    "number": "1710952999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600650917",
            "telephone_number": "847-504-5000",
            "fax_number": "847-504-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 SKOKIE BLVD STE 520",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621601",
            "telephone_number": "847-504-5000",
            "fax_number": "847-504-5015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "JERRY",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2019-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WI",
            "license": "886-25",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710952999",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01615149",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01743256",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah J Polak, RBT-18-65790
• Amy P Pollack, OT
• Alison Rose Pollan
• Mikayla Ilyssa Pollard, MA
• Daniel Polonsky, PSY.D.
• Stanley L. Porada, DPM
• Rylie Porretto
• Harriet Emerson Porter, ACSW, LCSW, BCD
• Ericka Potter
• Amber Brooke Potts, APRN

• Podiatrist in Northbrook, IL
• Providers in Northbrook, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.