DR. SHAWN POOLE (NPI# 1497315873) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497315873 |
| Entity Type | Individual |
| Full Name | DR. SHAWN POOLE |
| Credential | MD |
| Practice Address |
701 N 1st St # D346 Springfield IL 62702-3757 |
| Mailing Address |
Po Box 19638 Springfield IL 62794-9638 |
| Practice Telephone | 2175458856 |
| Practice Fax Number | 2175452563 |
| Mailing Telephone | 2175458856 |
| Mailing Fax Number | 2175452563 |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2019-06-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
125.074978 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
701 N 1ST ST # D346 |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-3757 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1952830473 | Ruhani Nanavati | Surgery | 701 N 1st St # D346, Springfield, IL 62702-3757 | 2017-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| 1588993430 | Lutheran Child and Family Services of Illinois | Foster Care Agency | 620 N. Walnut St., Springfield, IL 62702 | 2009-12-23 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1962791632 | Rishi Subbarayan | Surgery | 960 16th St, Springfield, OR 97477-4175 | 2011-04-04 |
| 1720220759 | Kathleen M Lamb | Surgery | 446 Kent Rd, Springfield, PA 19064-3306 | 2009-04-06 |
| 1417943937 | Kim J Hodgson | Surgery | 340 W Miller St, Springfield, IL 62702-4928 | 2005-09-20 |
| 1275525743 | Michael D Addis | Surgery | 649 Morris Ave, Springfield, NJ 07081-1518 | 2005-08-19 |
| 1861496242 | Springfield Surgery PC | Surgery | 322 Northcrest Dr, Springfield, TN 37172-3963 | 2005-06-13 |
| 1952830473 | Ruhani Nanavati | Surgery | 701 N 1st St # D346, Springfield, IL 62702-3757 | 2017-06-08 |
| 1356894521 | Tian Zhang | Surgery | 701 N 1st St, Springfield, IL 62702-3757 | 2016-07-25 |
| 1730528563 | Emily Marie Serafin | Surgery | 800 N 1st St, Springfield, IL 62702 | 2013-06-14 |
| 1518221704 | Ryan Nicholas Nolte | Surgery | 701 N 1st St, Springfield, IL 62702-3757 | 2012-07-02 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.