Active NPI
Courtland Polley, MD
- Surgery Physician
- Jacksonville, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- ME161701
- Practice address
- 4500 San Pablo Rd S
Jacksonville, FL 32224-1865 - Phone
- (904) 953-2000
- NPI assigned
- Apr 10, 2018
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | ME161701 | FL | Primary |
Addresses
Primary practice location
4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Mailing address
4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- General Surgery
- Education
- Florida Atlantic University, College of Medicine, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
836 Prudential Dr
Suite 1001
Jacksonville, FL 32207-8337
Phone (904) 398-0033
Hospital & facility affiliations
- Baptist Health Medical Center - Jacksonville
- Baptist Medical Center - Nassau
- Baptist Medical Center Beaches
Merit-based Incentive Payment System (MIPS)
- Final score
- 81.79 of 100
- Quality
- 64.42
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 74.88
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.24 of 100
- Quality
- 74.85
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 72.62
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 1-10 |
| Hernia repair - groin (open) | 1-10 |
| Hernia repair (minimally invasive) | 1-10 |
| Mastectomy | 1-10 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
| Removal of tissue | 1-10 |
| Removal of skin lesions | 1-10 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME161701 | FL | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mayo Clinic Jacksonville | Current | Accepting new patients | |
| North Florida Surgeons, PA | Current | Accepting new patients | |
| Mayo Clinic Jacksonville | Current | Accepting new patients | |
| North Florida Surgeons, PA | Surgery | Current | Accepting new patients |
| Mayo Clinic Jacksonville | Current | Accepting new patients |
Locations
4500 San Pablo Rd S
Jacksonville, FL 32224
Phone (904) 721-4815
836 Prudential Dr
Ste 1001
Jacksonville, FL 32207
Phone (904) 398-0004
11945 San Jose Blvd
Ste 102
Jacksonville, FL 32223
Phone (904) 268-3937
11945 San Jose Blvd
Ste 300
Jacksonville, FL 32223
Interoperability endpoints
- courtland.polley.1@9109.direct.athenahealth.com
- cpolley81198@direct.phhs.org
Organizations & group practices 5
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.
-
- Surgery Physician
- Jacksonville, FL
- NPI 1912953290
-
- Multi-Specialty Clinic/Center
- Jacksonville, FL
- NPI 1790772317
-
dba Mayo Clinic Home Infusion Pharmacy
- Home Infusion Therapy Pharmacy
- Jacksonville, FL
- NPI 1003510116
-
dba Mayo Clinic Jacksonville advanced care at home
- Health Service Clinic/Center
- Jacksonville, FL
- NPI 1174143986
-
dba NFS Florida Bone and Joint
- Orthopaedic Surgery Physician
- Gulf Breeze, FL
- NPI 1871442053
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Baptist Medical Center Nassau
- General Acute Care Hospital
- Fernandina Beach, FL
- NPI 1518024462
-
- General Acute Care Hospital
- Jacksonville Beach, FL
- NPI 1821155912
-
dba Baptist Medical Center
- General Acute Care Hospital
- Jacksonville, FL
- NPI 1578620449
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723680000000",
"number": "1164929790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 SAN PABLO RD S",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322241865",
"telephone_number": "904-953-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 SAN PABLO RD S",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322241865",
"telephone_number": "904-953-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLEY",
"first_name": "COURTLAND",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-10",
"last_updated": "2024-08-15",
"certification_date": "2024-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "FL",
"license": "ME161701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.