Active NPI
Brandon Edward Polasko, PA-C
- Physician Assistant
- Fairfax, VA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110005066
- Practice address
- 10100 Fairfax Blvd
Fairfax, VA 22030-2000 - Phone
- (703) 679-1876
- NPI assigned
- Jun 19, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110005066 | VA | Primary |
Addresses
Primary practice location
10100 Fairfax Blvd
Fairfax, VA 22030-2000
Mailing address
5000 Cox Rd
Glen Allen, VA 23060-9263
Phone (804) 968-5700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA, DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
10100 Fairfax Blvd
Fairfax, VA 22030-2000
Phone (703) 679-1876
2199 Old Bridge Rd
Woodbridge, VA 22192-2911
Phone (703) 357-9707
601 Potomac Station Dr
Leesburg, VA 20176-1816
Phone (703) 840-1396
6311 Richmond Hwy
Alexandria, VA 22306-6410
Phone (703) 647-6087
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110005066 | VA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Patient First Richmond Medical Group PLLC | Current | Accepting new patients | |
| Valley Regional Enterprises, Inc | Current | Accepting new patients | |
| Valley Regional Enterprises, Inc | Current | Accepting new patients | |
| Patient First Richmond Medical Group PLLC | Current | Accepting new patients |
Locations
6311 Richmond Hwy
Alexandria, VA 22306
Phone (703) 647-6087
10100 Fairfax Blvd
Fairfax, VA 22030
Phone (703) 679-1876
5000 Cox Rd
Glen Allen, VA 23060
Phone (804) 822-4355
601 Potomac Station Dr NE
Leesburg, VA 20176
Phone (703) 840-1396
607 E Jubal Early Dr
Winchester, VA 22601
Phone (540) 536-2232
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Medicine Physician
- Glen Allen, VA
- NPI 1689603748
DC
-
dba Valley Health Urgent Care
- Urgent Care Clinic/Center
- Winchester, VA
- NPI 1235178591
-
- Urgent Care Clinic/Center
- Fairfax, VA
- NPI 1588018881
-
dba Valley Health Quick Care
- Urgent Care Clinic/Center
- Strasburg, VA
- NPI 1063666196
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1144669540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5000 COX RD",
"city": "GLEN ALLEN",
"state": "VA",
"postal_code": "230609263",
"telephone_number": "804-968-5700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10100 FAIRFAX BLVD",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220302000",
"telephone_number": "703-679-1876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLASKO",
"first_name": "BRANDON",
"middle_name": "EDWARD",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-19",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110005066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.