DR. JEFFREY SCOTT POULTER M.D.
NPI 1174521074
Plastic Surgery in Bloomington, IL

Q: What is Jeffrey Poulter's NPI number?

The NPI number for Jeffrey Poulter is 1174521074. It was assigned to this individual provider in the NPPES registry on July 13, 2005.

Q: What is Jeffrey Poulter's specialty?

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

Q: Is Jeffrey Poulter enrolled in Medicare?

No. Jeffrey Poulter has opted out of Medicare through January 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Jeffrey Poulter was last updated on December 19, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 13, 2005Opted out of Medicare · through Jan 1, 2027

1505 EASTLAND DR, STE 350, BLOOMINGTON, IL 61701(309) 663-1222(309) 663-0580 Get Directions Write a Review

NPPES record last updated: December 19, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dr. Jeffrey Scott Poulter M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JEFFREY SCOTT POULTER M.D. (NPI 1174521074) is an individual plastic surgery provider in Bloomington, Illinois and active in the NPI registry since July 2005. He has opted out of Medicare through January 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1174521074

Entity TypeIndividualMale

Primary Taxonomy208200000X

Provider Legal NameDR. JEFFREY SCOTT POULTERCredential: M.D.

Location Address1505 EASTLAND DR, STE 350Bloomington, IL 61701-3534

Mailing Address1505 Eastland Dr, Ste 350Bloomington, IL 61701-3534 · (309) 663-1222 · Fax (309) 663-0580

Phone(309) 663-1222

Fax(309) 663-0580

Sole ProprietorYes

Enumeration DateJuly 13, 2005

Last NPPES UpdateDecember 19, 2007

✔ NPI 1174521074 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPlastic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208200000X

Definition

A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

Also ListedSurgery · Plastic and Reconstructive SurgeryTaxonomy 2086S0122X · License MDR5N96 (MO)

1505 EASTLAND DR, Bloomington, IL 61701

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Other Identifiers 3

Medicare UPINF27055IL

Medicare UPINF27055

Medicare PIN976430IL

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jeffrey Scott Poulter M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2021 through January 1, 2027.

Opt-Out Effective DateJanuary 1, 2021

Opt-Out In Effect ThroughJanuary 1, 2027Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61701 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$68.64 typical visit price

range $17.16 – $136.56

Typical copayment $17.16 (range $4.29 – $34.14)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. VENKATA RANGANADH DODDA MD

Internal Medicine (Critical Care Medicine)

1505 EASTLAND DR, SUITE 320
BLOOMINGTON, IL 61701

McLean County (309) 661-2368

DR. EDWARD LESLIE COLLOTON MD

Ophthalmology

1505 EASTLAND DR, STE 2200
BLOOMINGTON, IL 61701

McLean County (309) 662-7700

MS. MELANIE SCHALL

Pharmacist

1505 EASTLAND DR
BLOOMINGTON, IL 61701

McLean County (309) 664-0505

NORD OBSTETRICS AND GYNECOLOGY, SC

Obstetrics & Gynecology

1505 EASTLAND DR, #230
BLOOMINGTON, IL 61701

McLean County (309) 663-8888

KENNETH H. INOUE

Internal Medicine

1505 EASTLAND DR
BLOOMINGTON, IL 61701

McLean County (309) 661-2368

MCLEAN COUNTY ANESTHESIOLOGY, LTD.

Anesthesiology (Pain Medicine)

1505 EASTLAND DR, SUITE LL 1400
BLOOMINGTON, IL 61701

McLean County (309) 663-4700

CAROLINE J TURNER APN

Nurse Practitioner

1505 EASTLAND DR
BLOOMINGTON, IL 61701

McLean County (309) 665-4040

DANIELLE BEER

Physician Assistant

1505 EASTLAND DR
BLOOMINGTON, IL 61701

McLean County (309) 663-2100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jeffrey Poulter's NPI number?

The NPI number for Jeffrey Poulter is 1174521074. It was assigned to this individual provider in the NPPES registry on July 13, 2005.

Where is Jeffrey Poulter located?

Jeffrey Poulter practices at 1505 Eastland Dr Ste 350, Bloomington, IL 61701. The listed phone number is (309) 663-1222.

What is Jeffrey Poulter's specialty?

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

Is Jeffrey Poulter enrolled in Medicare?

No. Jeffrey Poulter has opted out of Medicare through January 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jeffrey Poulter was last updated on December 19, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.