Individual provider Active NPI

Miranda Polaski, PA

  • Physician Assistant
  • Southington, CT
National Provider Identifier
1003307554
Registry record updated Aug 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4140 Issued in CT
Practice address
81 Meriden Ave
Southington, CT 06489
Phone
(860) 276-5000
NPI assigned
May 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4140 CT Primary

Addresses

Primary practice location

81 Meriden Ave
Southington, CT 06489

Mailing address

81 Meriden Ave
Southington, CT 06489-3268

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180906000527 CT Practitioner - Physician Assistant 6901156322 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.05 of 100Reported as group
Quality
84.92
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as group
Quality
83.66
Promoting interoperability
100
Improvement activities
40
Cost
66.78

Merit-based Incentive Payment System (MIPS)

Final score
84.01 of 100Reported as group
Quality
71.79
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4140CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Midstate Medical Center CurrentSince Apr 1, 2020 Accepting new patients
The Hospital of Central Connecticut at New Britain General and Bradley CurrentSince Aug 12, 2018 Accepting new patients
The Hospital of Central Connecticut at New Britain General and Bradley CurrentSince Aug 12, 2018 Accepting new patients

Locations

435 Lewis Ave
Meriden, CT 06451
Phone (203) 284-1340

100 Grand St
#B
New Britain, CT 06052

100 Grand St
New Britain, CT 06052
Phone (860) 224-5011

81 Meriden Ave
Southington, CT 06489
Phone (860) 224-5540

Interoperability endpoints

  • Direct secure messaging: miranda.polaski@xdr.hhchealthdirect.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534896000000",
    "number": "1003307554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 MERIDEN AVE",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064893268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 MERIDEN AVE",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "06489",
            "telephone_number": "860-276-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLASKI",
        "first_name": "MIRANDA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-21",
        "last_updated": "2018-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "4140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southington, CT

Sources for this page

Verify at the official NPI Registry.