npidexNPI registry + Medicare data

JEFFREY POULTER, M.D.

Plastic Surgery Physician · BLOOMINGTON, IL

Individual Active Opted out of Medicare NPI 1174521074

Taxonomy & licensure

SpecialtyCodePrimaryLicenseState
Plastic Surgery Physician208200000X✓—IL
Plastic and Reconstructive Surgery Physician2086S0122XMDR5N96MO
Plastic and Reconstructive Surgery Physician2086S0122X—IL

Medicare eligibility

Part B
Yes
DME
Yes
Home health
Yes
Power mobility
Yes
Hospice
Yes

Opted out of Medicare (Plastic And Reconstructive Surgery), effective 2021-01-01 through 2027-01-01.

Other Plastic Surgery Physician providers in Illinois

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Source: NPPES (public domain) and CMS Medicare Physician & Other Practitioners data. Not affiliated with CMS, NPPES, or any government agency.