DR. NICHOLAS D. POULOS (MD) – Pediatric Surgery Physician, NPI 1669446894
Pediatric Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. NICHOLAS D. POULOS (MD)
10140 CENTURION PKWY N
JACKSONVILLE, FL 322560532
Phone: (904) 697-4100
Type: Mailing
6535 NEMOURS PKWY
ORLANDO, FL 328277884
Phone: (407) 650-7000
Fax: (407) 567-5924
Type: Location
191, Mill Street, Rockport, Knox County, Maine, 04856, United States
PROVIDER ENROLLMENT DEPT
ROCKLAND, DE 197320191
Phone: (302) 651-6212
Fax: (302) 651-6212
Type: Mailing
Nemours Children's Specialty Care, 807, Childrens Way, Jacksonville, Duval County, Florida, 32207, United States
JACKSONVILLE, FL 322078426
Phone: (904) 390-3600
Fax: (904) 390-3491
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $96.
Total Amount is formed as General ($96) + Research ($0) + Ownership ($0) = $96.
Last reported payment date: 2024-11-15 • Largest payer in this snapshot: Janssen Biotech, Inc. ($41).
Total Amount
$96
General + Research + Ownership
Payments
5
Total payment records
General Amount
$96
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-15
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Janssen Biotech, Inc. | $41 |
| Hologic Sales and Service, LLC | $27 |
| Ethicon US, LLC | $14 |
| Dentsply Sirona Inc | $14 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-02-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040911000064 | I | General Surgery | FL | TBD |
| I20170216001604 | I | General Surgery | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32256)
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