Individual provider Active NPI

Samuel O. Poore, M.D., PH.D.

  • Plastic Surgery Physician
  • Madison, WI
National Provider Identifier
1760425433
Registry record updated Dec 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
49936 Issued in WI
Practice address
600 Highland Ave
Madison, WI 53792-0001
Phone
(608) 263-7502
Fax
(608) 265-9695
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 49936 WI Primary

Addresses

Primary practice location

600 Highland Ave
Madison, WI 53792-0001

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address spoore7312@direct.uwhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100713000694 WI Practitioner - Plastic and Reconstructive Surgery 8325170293 Reassigns benefits to 1 organization
I20220111001413 IL Practitioner - Plastic and Reconstructive Surgery 8325170293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Warren Alpert Medical School of Brown University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

600 Highland Ave
Madison, WI 53792-0001
Phone (608) 263-6400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.32 of 100Reported as group
Quality
87.78
Promoting interoperability
77
Improvement activities
40
Cost
75.8

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy36
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Wisconsin Medical Foundation, Inc CurrentSince Sep 1, 2010 Accepting new patients
Swedishamerican Hospital CurrentSince Jan 3, 2022 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Sep 1, 2010 Accepting new patients
Swedishamerican Hospital CurrentSince Jan 3, 2022 Accepting new patients

Locations

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

2550 Charles St
Rockford, IL 61108
Phone (779) 696-7285

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

Organizations & group practices 4

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 1

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": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1760425433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 HIGHLAND AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537920001",
            "telephone_number": "608-263-7502",
            "fax_number": "608-265-9695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POORE",
        "first_name": "SAMUEL",
        "middle_name": "O.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "WI",
            "license": "49936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spoore7312@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "600 Highland Ave",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537920001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.