Individual provider Active NPI

Sally Cecile Pollock, FNP

  • Nurse Practitioner
  • Onalaska, WI
National Provider Identifier
1073863684
Registry record updated Oct 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
7727 Issued in WI
Practice address
191 Theater Rd
Onalaska, WI 54650
Phone
(608) 785-0940
NPI assigned
Sep 12, 2012
Last updated
Oct 12, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 7727 WI Primary
Nurse Practitioner 363L00000X 160229 WI
Nurse Practitioner 363L00000X 0702 MN
Family Nurse Practitioner 363LF0000X R1668894 MN

Addresses

Primary practice location

191 Theater Rd
Onalaska, WI 54650

Mailing address

200 1St St SW
Rochester, MN 55905-0001
Phone (608) 785-0940

Other practice location 1

420 E Sarnia St
Winona, MN 55987-6365
Phone (507) 474-7830

Other names 1

  • Sally Cecile Ustby Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address spollock33545@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20170713002728 WI Practitioner - Nurse Practitioner 5890947238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

191 Theater Rd
Onalaska, WI 54650-8679
Phone (608) 392-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0702MNMDNurse Practitioner
160229WIMDNurse Practitioner
7727WIMDNurse Practitioner
R1668894MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Jun 27, 2017 Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Jun 27, 2017 Accepting new patients

Locations

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

191 Theater Rd
Onalaska, WI 54650
Phone (608) 392-5000

705 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 357-2000

800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808

310 W Main St
Sparta, WI 54656
Phone (608) 269-1700

Interoperability endpoints

  • Direct secure messaging: spollock33545@ehrdirect.mayoclinicmsg.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1073863684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "608-785-0940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 THEATER RD",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "54650",
            "telephone_number": "608-785-0940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 E Sarnia St",
            "address_purpose": "LOCATION",
            "city": "Winona",
            "state": "MN",
            "postal_code": "559876365",
            "country_code": "US",
            "telephone_number": "507-474-7830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLLOCK",
        "first_name": "SALLY",
        "middle_name": "CECILE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-12",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "7727",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "160229",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "0702",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R1668894",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spollock33545@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "191 Theater Rd",
            "city": "Onalaska",
            "state": "WI",
            "country_code": "US",
            "postal_code": "54650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "USTBY",
            "middle_name": "CECILE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Onalaska, WI

Sources for this page

Verify at the official NPI Registry.