NPIMap

Individual provider Active NPI

Despina Melissa Poulos, MD

  • Family Medicine Physician
  • Charleston, WV
National Provider Identifier
1861671984
Registry record updated May 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
24286 Issued in WV
Practice address
3200 Maccorkle Ave SE
Hospitalists Program
Charleston, WV 25304-1227
Phone
(304) 388-5848
Fax
(304) 388-9654
NPI assigned
Oct 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 24286 WV Primary

Addresses

Primary practice location

3200 Maccorkle Ave SE
Hospitalists Program
Charleston, WV 25304-1227

Mailing address

415 Morris St
Suite 304
Charleston, WV 25301-1842
Phone (304) 388-7782

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, OH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110119001293 WV Practitioner - HospitalistPractitioner - Family PracticePractitioner - Internal Medicine 8325227507 Reassigns benefits to 1 organization
I20250207002017 OH Practitioner - Family Practice 8325227507 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

400 Association Dr
Suite 102
Charleston, WV 25311-1298

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24286WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. Current Accepting new patients
The Cleveland Clinic Foundation CurrentSince Jan 15, 2025 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Nov 5, 2011 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Nov 5, 2011 Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Locations

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

415 Morris St
Ste 304
Charleston, WV 25301

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

415 Morris St
Ste 309
Charleston, WV 25301
Phone (304) 348-3290

3703 Teays Valley Rd
Hurricane, WV 25526
Phone (304) 757-2273

Organizations & group practices 5

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 11

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": "1193270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305072000000",
    "number": "1861671984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 MORRIS ST",
            "address_2": "SUITE 304",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011842",
            "telephone_number": "304-388-7782",
            "fax_number": "304-388-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 MACCORKLE AVE SE",
            "address_2": "HOSPITALISTS PROGRAM",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041227",
            "telephone_number": "304-388-5848",
            "fax_number": "304-388-9654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULOS",
        "first_name": "DESPINA",
        "middle_name": "MELISSA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-25",
        "last_updated": "2011-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "24286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.