Individual provider Active NPI

Andrea Helen Polesky, MD

  • Infectious Disease Physician
  • San Ysidro, CA
National Provider Identifier
1063517365
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
G81333 Issued in CA
Practice address
4004 Beyer Blvd
San Ysidro, CA 92173-2007
Phone
(619) 662-4100
NPI assigned
Sep 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G81333 CA
Infectious Disease Physician 207RI0200X G81333 CA Primary

Addresses

Primary practice location

4004 Beyer Blvd
San Ysidro, CA 92173-2007

Mailing address

1601 Precision Park LN
San Diego, CA 92173-1345
Phone (619) 936-3823

Other identifiers 1

IdentifierTypeStateIssuer
00G813330MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20090213000508 CA Practitioner - Infectious DiseasePractitioner - Internal Medicine 0840355434 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Yale University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4004 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 428-4463

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G81333CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro, Inc. CurrentSince Jan 6, 2025 Accepting new patients
County of Santa Clara Internal Medicine CurrentSince Mar 1, 2000 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Jan 6, 2025 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
County of Santa Clara Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Past Accepting new patients

Locations

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

435 H St
Chula Vista, CA 91910
Phone (619) 691-7000

7475 Camino Arroyo
Gilroy, CA 95020
Phone (408) 852-2400

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

1996 Lundy Ave
San Jose, CA 95131
Phone (408) 299-5846

500 Tully Rd
San Jose, CA 95111
Phone (408) 817-1433

750 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-2320

2101 Alexian Dr
San Jose, CA 95116
Phone (408) 272-6050

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

1993 McKee Rd
San Jose, CA 95116
Phone (408) 254-6320

1650 Las Plumas Ave
Ste K
San Jose, CA 95133
Phone (408) 272-6726

1601 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 205-4585

4004 Beyer Blvd
San Ysidro, CA 92173
Phone (619) 428-1330

660 S Fair Oaks Ave
Sunnyvale, CA 94086
Phone (408) 885-7366

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: apolesky58499@syhealth.direct-ci.com

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": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1063517365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 PRECISION PARK LN",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921731345",
            "telephone_number": "619-936-3823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 BEYER BLVD",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921732007",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLESKY",
        "first_name": "ANDREA",
        "middle_name": "HELEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G81333",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CA",
            "license": "G81333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G813330",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Ysidro, CA

Sources for this page

Verify at the official NPI Registry.