Polo Alberto Banuelos, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

ME158919 Issued in FL

Practice address

11212 State Highway 151
Medical Plaza 1, Suite 200
San Antonio, TX 78251-4498

Phone

(210) 520-7160

Fax

(210) 520-7190

NPI assigned

Aug 4, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Neurology

Education

Baylor College of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baycare Medical Group, Inc.Group PAC ID 6406753623, 1,539 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Anthonys Hospital Hospital, Saint Petersburg, FL, CCN 100067

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pbanuelos390073@direct-ehr-ssmhc.com
• Direct secure messaging: polo.banuelosmd@direct.mybaycare.org
• Direct secure messaging: polo.banuelos@hca8.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Baycare Medical Group, Inc.

  • General Practice Physician
  • Clearwater, FL
  • NPI 1043269871

  Neurology

  Medicare reassignment Care Compare group NPD
• Baycare Medical Group, Inc.

  • Family Medicine Physician
  • Clearwater, FL
  • NPI 1659720837
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St. Anthonys Hospital, Inc.

  • General Acute Care Hospital
  • St Petersburg, FL
  • NPI 1427024942
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677456000000",
    "number": "1003072646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9730 WESTOVER HILLS BLVD STE 105",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782514842",
            "telephone_number": "210-520-7160",
            "fax_number": "210-520-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11212 STATE HIGHWAY 151",
            "address_2": "MEDICAL PLAZA 1, SUITE 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782514498",
            "telephone_number": "210-520-7160",
            "fax_number": "210-520-7190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1055 Bowles Ave",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "St. Louis",
            "state": "MO",
            "postal_code": "63117",
            "country_code": "US",
            "telephone_number": "314-925-4773",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Pinellas St # 47",
            "address_purpose": "LOCATION",
            "city": "Clearwater",
            "state": "FL",
            "postal_code": "337563804",
            "country_code": "US",
            "telephone_number": "727-462-7907",
            "fax_number": "727-462-7904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANUELOS",
        "first_name": "POLO",
        "middle_name": "ALBERTO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-04",
        "last_updated": "2023-02-27",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": "M9832",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME158919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pbanuelos390073@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "pbanuelos390073@direct-ehr-ssmhc.com",
            "address_1": "1055 Bowles Ave",
            "address_2": "Suite 200",
            "city": "St. Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "63117",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR-API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1055 Bowles Ave",
            "address_2": "Suite 200",
            "city": "St. Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "63117",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "polo.BanuelosMD@direct.mybaycare.org",
            "affiliation": "Y",
            "affiliationName": "BayCare Medical Group, Inc.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2995 Drew St Fl 2",
            "city": "Clearwater",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337593012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Linda J. Banta, M.D.
• Surbhi Banubakode
• Angelina S Banuelos-Gonzalez, RDN
• Alma Banuelos, LPC-S
• Elizabeth Banuelos, COTA
• Kay Gritzke Banus
• Bao Nguyen, D.C., P.a.
• Lisa Bao, MAT, LAT, ATC, CES
• Ryan Nghi Bao, DO
• Baptist Diagnostics, LLC

• Neurology Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Neurology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.