Thomas L Poulton, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD196953 Issued in OR

Practice address

500 5TH St
Brookings, OR 97415-9702

Phone

(541) 412-2000

NPI assigned

Sep 27, 2006

Last updated

Sep 1, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ME

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: thomas.poulton.1@21577.direct.athenahealth.com
• Direct secure messaging: tpoulton@yourcarecommunity.org

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.

• Northern Maine Medical Center

  • Critical Access Hospital
  • Fort Kent, ME
  • NPI 1568465144
  Medicare reassignment NPD
• Northern Maine Medical Center

  dba St John Valley Pharmacy

  • Community/Retail Pharmacy
  • Fort Kent, ME
  • NPI 1952303422
  NPD
• Evanston Clinic Corp

  • Family Medicine Physician
  • Evanston, WY
  • NPI 1013916519

  Urology

  NPD (past)
• Franciscan Medical Group

  • Family Medicine Physician
  • Tacoma, WA
  • NPI 1366539421
  NPD (past)
• Tacoma Radiation Oncology Center Inc, PS

  dba Tacoma Valley Radiation Oncology Centers

  • Radiation Oncology Physician
  • Tacoma, WA
  • NPI 1255449146
  NPD (past)

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1902997836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94220 4TH ST",
            "city": "GOLD BEACH",
            "state": "OR",
            "postal_code": "974447756",
            "telephone_number": "541-247-3910",
            "fax_number": "541-247-3109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 5TH ST",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974159702",
            "telephone_number": "541-412-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "314 Martin Luther King Jr Way",
            "address_2": "Suite 208",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984054250",
            "country_code": "US",
            "telephone_number": "253-503-1273",
            "fax_number": "253-507-8854",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "94220 4th St",
            "address_purpose": "LOCATION",
            "city": "Gold Beach",
            "state": "OR",
            "postal_code": "974447756",
            "country_code": "US",
            "telephone_number": "541-247-3910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POULTON",
        "first_name": "THOMAS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WA",
            "license": "MD 602 15304",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OR",
            "license": "MD196953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "R217930",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CURRY GENERAL HOSPITAL NPI",
            "identifier": "1487696985",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "None",
            "affiliation": "N",
            "address_1": "500 5th St",
            "city": "Brookings",
            "state": "OR",
            "country_code": "US",
            "postal_code": "974159702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Julie Catherine Peterson
• Robert W. Petzold, M.D.
• Nicole Pezzullo
• Sandra Phillips
• Nancy Diane Porter
• Precision Eyecare P.C.
• Callie A Preston
• Mickey J Price, PSY.D.
• Primal Care Wellness LLC
• Joshua Pruden

• Urology Physician in Brookings, OR
• Providers in Brookings, OR by specialty
• Urology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; 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.