Individual provider Active NPI

Kimberly Hansen Polonsky, FNP-BC

  • Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1073954590
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5006279 Issued in NC
Practice address
1918 Randolph Rd Ste 275
Charlotte, NC 28207-1109
Phone
(704) 384-1354
Fax
(704) 384-1374
NPI assigned
Jul 12, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 236192 NC
Nurse Practitioner 363L00000X 5006279 NC Primary

Addresses

Primary practice location

1918 Randolph Rd Ste 275
Charlotte, NC 28207-1109

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

5301 Wilkinson Blvd
Charlotte, NC 28208-5455
Phone (704) 316-6561

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kpolonsky887493@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20170512000048 NC Practitioner - Nurse Practitioner 8820226558 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

1918 Randolph Rd
Suite 275
Charlotte, NC 28207-1109
Phone (704) 384-1354

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5006279NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 14, 2021 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 14, 2021 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

1918 Randolph Rd
Ste 275
Charlotte, NC 28207
Phone (704) 342-8185

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

8401 Medical Plaza Dr
Ste 300
Charlotte, NC 28262
Phone (704) 316-1800

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Organizations & group practices 4

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.

Hospital & facility affiliations 4

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": "1373587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1073954590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 RANDOLPH RD STE 275",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071109",
            "telephone_number": "704-384-1354",
            "fax_number": "704-384-1374"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5301 Wilkinson Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282085455",
            "country_code": "US",
            "telephone_number": "704-316-6561",
            "fax_number": "704-384-1977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLONSKY",
        "first_name": "KIMBERLY",
        "middle_name": "HANSEN",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-12",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "236192",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5006279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpolonsky887493@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1918 Randolph Rd Ste 275",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282071109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.