Gustavo Emil Polanco Hernandez, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

029357 Issued in NY

Practice address

2015 Grand Concourse
Bronx, NY 10453-4303

Phone

(718) 583-7736

Fax

(718) 537-6180

NPI assigned

Sep 30, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Shakespeare Operating LLCGroup PAC ID 0840604310, 144 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

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.

• Shakespeare Operating LLC

  • Multi-Specialty Clinic/Center
  • Bronx, NY
  • NPI 1720634538
  Medicare reassignment Care Compare group
• Essen Medical Associates, PC

  • Legal Medicine
  • Bronx, NY
  • NPI 1366418709
  Medicare reassignment NPD
• Essen Medical Urgicare, PLLC

  • Urgent Care Clinic/Center
  • Bronx, NY
  • NPI 1841607298
  Medicare reassignment
• Essen Medical Associates, PC

  • Podiatrist
  • Bronx, NY
  • NPI 1720799158
  NPD

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

{
    "created_epoch": "1569801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1013558188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 HALPERIN AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612631",
            "telephone_number": "718-618-0401",
            "fax_number": "347-479-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104534303",
            "telephone_number": "718-583-7736",
            "fax_number": "718-537-6180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLANCO HERNANDEZ",
        "first_name": "GUSTAVO",
        "middle_name": "EMIL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-30",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "FL",
            "license": "PA9112633",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "PA9112633",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112633",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "FL",
            "license": "PA9112633",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9112633",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "029357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maxwell Robert Poirier, MD
• Sita Pokhrel
• Priscilla Amma Pokuaah
• Anita Afiriyie Pokuh, FNP
• Emily Polak
• Virleny Polanco Ortega, NP
• Clavel Polanco Ruiz, LMSW
• Yeny M. Polanco-Castillo, LCSW, CASAC
• Angel Polanco, CASAC
• Benny Polanco, REGISTERED NURSE

• Physician Assistant in Bronx, NY
• Providers in Bronx, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.