Active NPI
Susan Jeanne Polis, DDS
- General Practice Dentistry
- Homer, AK
National Provider Identifier
1023144540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 935
- Practice address
- 549 Grubstake Ave
Suite a
Homer, AK 99603-7640 - Phone
- (907) 235-1286
- Fax
- (907) 235-1263
- NPI assigned
- Feb 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 935 | AK | Primary |
Addresses
Primary practice location
549 Grubstake Ave
Suite a
Homer, AK 99603-7640
Mailing address
549 Grubstake Ave
Suite a
Homer, AK 99603-7640
Phone (907) 235-1286
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D951 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 935 | AK | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Preventive Dental Services, a Professional Corporation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Homer, AK
- NPI 1922341734
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023144540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "549 GRUBSTAKE AVE",
"address_2": "SUITE A",
"city": "HOMER",
"state": "AK",
"postal_code": "996037640",
"telephone_number": "907-235-1286",
"fax_number": "907-235-1263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "549 GRUBSTAKE AVE",
"address_2": "SUITE A",
"city": "HOMER",
"state": "AK",
"postal_code": "996037640",
"telephone_number": "907-235-1286",
"fax_number": "907-235-1263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLIS",
"first_name": "SUSAN",
"middle_name": "JEANNE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AK",
"license": "935",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D951",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Homer, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.