Jaise Thekkan Poulose, MD in Fargo, ND - Medicare Critical Care (intensivists)

Jaise Thekkan Poulose, MD is a medicare enrolled "Internal Medicine - Critical Care Medicine" physician in Fargo, North Dakota. He graduated from medical school in 2001 and has 23 years of diverse experience with area of expertise as Critical Care (intensivists). He is a member of the group practice Jennie Stuart Medical Center Inc and his current practice location is 3000 32nd Ave S, Fargo, North Dakota. You can reach out to his office (for appointments etc.) via phone at (701) 364-8000.

Jaise Thekkan Poulose is licensed to practice in Kentucky (license number 53941) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1497872675.

Contact Information

	Jaise Thekkan Poulose, MD
	3000 32nd Ave S, Fargo, ND 58103-6132
	(701) 364-8000
	(701) 364-8078

Map and Direction

Physician's Profile

Full Name	Jaise Thekkan Poulose
Gender	Male
Speciality	Critical Care (intensivists)
Experience	23 Years
Location	3000 32nd Ave S, Fargo, North Dakota
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Jaise Thekkan Poulose graduated from medical school in 2001

NPI Data:

NPI Number: 1497872675
Provider Enumeration Date: 03/23/2007
Last Update Date: 03/24/2021

Medicare PECOS Information:

PECOS PAC ID: 6002916723
Enrollment ID: I20200710002790

Medical Identifiers

Medical identifiers for Jaise Thekkan Poulose such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1497872675	NPI	-	NPPES
7100672860	Medicaid	KY
ENROLLED	Medicaid	IA
ENROLLED	Medicaid	MN
N714361	Medicaid	ND
35190900	Medicaid	WI
913427000	Medicaid	MN
10502	Medicaid	ND

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207RC0000X	Internal Medicine - Cardiovascular Disease	11150 (North Dakota)	Secondary
207RC0200X	Internal Medicine - Critical Care Medicine	50104 (Minnesota)	Secondary
207RP1001X	Internal Medicine - Pulmonary Disease	MD.207663 (Louisiana)	Secondary
207RC0200X	Internal Medicine - Critical Care Medicine	53941 (Kentucky)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Jennie Stuart Medical Center	Hopkinsville, KY	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Jennie Stuart Medical Center Inc	4183607252	99

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jaise Thekkan Poulose allows following entities to bill medicare on his behalf.

Entity Name	Jennie Stuart Medical Center Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1235139312 PECOS PAC ID: 4183607252 Enrollment ID: O20040609001506

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jaise Thekkan Poulose is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Jaise Thekkan Poulose, MD Po Box 2400, Hopkinsville, KY 42241-2400 Ph: (270) 887-0100	Jaise Thekkan Poulose, MD 3000 32nd Ave S, Fargo, ND 58103-6132 Ph: (701) 364-8000

Reviews and Comments

Internal Medicine Doctors in Fargo, ND

Dr. Keri Lynn Crewson, M.D. Critical Care Medicine Medicare: Accepting Medicare Assignments Practice Location: Sanford Health, 801 Broadway North, Fargo, ND 58122 Phone: 701-234-5933 Fax: 701-234-7230
Abdallah M Mansour, MD Critical Care Medicine Medicare: Medicare Enrolled Practice Location: 3000 32nd Ave S, Fargo, ND 58103 Phone: 701-364-8900
Derek Anderson, DO Critical Care Medicine Medicare: Not Enrolled in Medicare Practice Location: 5225 23rd Ave S, Fargo, ND 58104 Phone: 701-234-5933
Gerald G Gross, MD Critical Care Medicine Medicare: Accepting Medicare Assignments Practice Location: 820 4th St N, Fargo, ND 58102 Phone: 701-234-6161
Paul James Carson, MD Critical Care Medicine Medicare: Accepting Medicare Assignments Practice Location: 801 Broadway N, Fargo, ND 58102 Phone: 701-234-4811 Fax: 701-234-6979
Howard L Russell, MD Critical Care Medicine Medicare: Accepting Medicare Assignments Practice Location: 820 N 4th St, Fargo, ND 58122 Phone: 701-234-6161 Fax: 701-234-3861
Dr. Emuejevoke Joseph Okoh, M.D. Critical Care Medicine Medicare: Accepting Medicare Assignments Practice Location: 801 Broadway N, Fargo, ND 58102 Phone: 701-234-2000

Jaise Thekkan Poulose, MD - Medicare Critical Care (intensivists) in Fargo, ND