Individual provider Active NPI

Brandon Edward Polasko, PA-C

  • Physician Assistant
  • Fairfax, VA
National Provider Identifier
1144669540
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110005066 Issued in VA
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

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20151102000287 VA Practitioner - Physician Assistant 1759512494 Reassigns benefits to 2 organizations
I20171017001008 DC Practitioner - Physician Assistant 1759512494 Reassigns benefits to 1 organization

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

LicenseStateTypeSpecialty
0110005066VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Patient First Richmond Medical Group PLLC CurrentSince Aug 9, 2017 Accepting new patients
Valley Regional Enterprises, Inc CurrentSince Sep 10, 2015 Accepting new patients
Valley Regional Enterprises, Inc CurrentSince Sep 10, 2015 Accepting new patients
Patient First Richmond Medical Group PLLC CurrentSince Aug 9, 2017 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.

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

Verify at the official NPI Registry.