Active NPI
Michael E Poole, D.O.
- Family Medicine Physician
- Fairfield, IA
National Provider Identifier
1821105537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01659
- Practice address
- 2000 South Main Street
Ste C
Fairfield, IA 52556-3739 - Phone
- (641) 472-4141
- NPI assigned
- Aug 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01659 | IA | Primary |
Addresses
Primary practice location
2000 South Main Street
Ste C
Fairfield, IA 52556-3739
Mailing address
2000 South Main Street
Ste C
Fairfield, IA 52556-3739
Phone (641) 472-4141
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3210534 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248220800000",
"number": "1821105537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 SOUTH MAIN STREET",
"address_2": "STE C",
"city": "FAIRFIELD",
"state": "IA",
"postal_code": "525563739",
"telephone_number": "641-472-4141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 SOUTH MAIN STREET",
"address_2": "STE C",
"city": "FAIRFIELD",
"state": "IA",
"postal_code": "525563739",
"telephone_number": "641-472-4141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POOLE",
"first_name": "MICHAEL",
"middle_name": "E",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-25",
"last_updated": "2009-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "01659",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3210534",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2009; 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.