Stephen Poulos, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME156827 Issued in FL

Practice address

3372 Woods Edge Cir Ste 101
Bonita Springs, FL 34134-3436

Phone

(239) 799-7873

NPI assigned

Jun 24, 2013

Last updated

Sep 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OH

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: stephen.poulos.1@6965.direct.athenahealth.com

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.

• Alliance Physicians Inc

  dba Kettering Health Medical Group

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1437125572

  Psychiatry

  Medicare reassignment NPD
• Defiance Hospital, Inc.

  dba Defiance Rehabilitation Services

  • Physical Therapy Clinic/Center
  • Defiance, OH
  • NPI 1629216684
  Medicare reassignment NPD
• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment NPD
• Alliance Physicians Inc

  dba Kettering Behavioral Medicine Center

  • Psychiatry Physician
  • Moraine, OH
  • NPI 1780852228
  NPD

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

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1922447960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3372 WOODS EDGE CIR STE 101",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341343436",
            "telephone_number": "239-799-7873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3372 WOODS EDGE CIR STE 101",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341343436",
            "telephone_number": "239-799-7873"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 Ralston Ave",
            "address_purpose": "LOCATION",
            "city": "Defiance",
            "state": "OH",
            "postal_code": "435121396",
            "country_code": "US",
            "telephone_number": "419-783-4418",
            "fax_number": "419-783-6957",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5348 Lamme Rd",
            "address_purpose": "LOCATION",
            "city": "Moraine",
            "state": "OH",
            "postal_code": "454393215",
            "country_code": "US",
            "telephone_number": "937-534-4651",
            "fax_number": "937-522-8779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POULOS",
        "first_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-24",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "MDST768",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "35131835",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WY",
            "license": "11396A",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME156827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spoulos787247@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "5348 Lamme Rd",
            "city": "Moraine",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454393215",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "5348 Lamme Rd",
            "city": "Moraine",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454393215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wally Plante, MD
• Play to Heal Collective, Inc.
• Morgan Plocharczyk, DPT
• Virgil Anthony Ponzoli Jr., MD
• Juliette Porto, APRN
• Preferred Senior Care LLC (Senior Helpers Of S.W. FL)
• Preventative Medicine Group, LLC
• Donald Lee Price
• Scott R Prickett, O.D.
• Prime Medical Health and Wellness LLC

• Psychiatry Physician in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; 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.