Active NPI
Jennifer A Polley, MD
- Pediatrics Physician
- Centralia, WA
National Provider Identifier
1114089026
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD00027525
- Practice address
- 1911 Cooks Hill Rd.
Centralia, WA 98531 - Phone
- (360) 736-6778
- Fax
- (360) 736-6552
- NPI assigned
- Dec 15, 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD00027525 | WA | Primary |
Addresses
Primary practice location
1911 Cooks Hill Rd.
Centralia, WA 98531
Mailing address
1911 Cooks Hill Rd.
Centralia, WA 98531
Phone (360) 736-6778
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1058825 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 31, 2013 through Dec 31, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00027525 | WA | MD | Pediatrics Physician |
Interoperability endpoints
- jpolley@nwpc.opdirect.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274054400000",
"number": "1114089026",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1911 COOKS HILL RD.",
"city": "CENTRALIA",
"state": "WA",
"postal_code": "98531",
"telephone_number": "360-736-6778",
"fax_number": "360-736-6552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1911 COOKS HILL RD.",
"city": "CENTRALIA",
"state": "WA",
"postal_code": "98531",
"telephone_number": "360-736-6778",
"fax_number": "360-736-6552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLEY",
"first_name": "JENNIFER",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-15",
"last_updated": "2010-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WA",
"license": "MD00027525",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1058825",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Centralia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.