Active NPI
Ann Lucretia Polich, MD
- Internal Medicine Physician
- Omaha, NE
National Provider Identifier
1033291406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 19125
- Practice address
- 208 S 26TH Ave
Omaha, NE 68131-3622 - Phone
- (402) 354-3198
- Fax
- (402) 354-3199
- NPI assigned
- Oct 19, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 19125 | NE | Primary |
Addresses
Primary practice location
208 S 26TH Ave
Omaha, NE 68131-3622
Mailing address
PO Box 2797
Omaha, NE 68103-2797
Phone (402) 354-4230
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10026485712 | Medicaid | NE | |
| 1033291406 | Medicaid | IA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19125 | NE | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547424000000",
"number": "1033291406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2797",
"city": "OMAHA",
"state": "NE",
"postal_code": "681032797",
"telephone_number": "402-354-4230",
"fax_number": "402-354-6171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 S 26TH AVE",
"city": "OMAHA",
"state": "NE",
"postal_code": "681313622",
"telephone_number": "402-354-3198",
"fax_number": "402-354-3199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLICH",
"first_name": "ANN",
"middle_name": "LUCRETIA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2019-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NE",
"license": "19125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10026485712",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1033291406",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.