Polly Godfrey, MD

Primary specialty

Hospitalist PhysicianTaxonomy code 208M00000X

License

036155636 Issued in IL

Practice address

2650 Ridge Ave.
Im Hospitalists Ste 4206
Evanston, IL 60201

Phone

(847) 570-1010

Fax

(847) 733-5108

NPI assigned

Mar 29, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, IL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Hospitalist

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ascension Medical Group-Southeast Wisconsin IncGroup PAC ID 8628980943, 551 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension All Saints Hospital Hospital, Racine, WI, CCN 520096

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Ascension Medical Group-Southeast Wisconsin Inc

  • Internal Medicine Physician
  • Glendale, WI
  • NPI 1609881077

  Multi-Specialty, WI

  Medicare reassignment Care Compare group NPD
• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882

  IL, Multi-Specialty

  Medicare reassignment NPD
• Columbia St. Mary'S Hospital Milwaukee, Inc

  • Multi-Specialty Clinic/Center
  • Milwaukee, WI
  • NPI 1023064482

  Multi-Specialty, WI

  Medicare reassignment NPD
• Endeavor Health Medical Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944

  Multi-Specialty

  NPD
• Columbia St. Mary'S Hospital Milwaukee Inc

  • Psychiatric Hospital Unit
  • Mequon, WI
  • NPI 1417600909
  NPD
• Columbia St. Mary'S Hospital Milwaukee, Inc

  • Multi-Specialty Clinic/Center
  • Mequon, WI
  • NPI 1710928221

  Multi-Specialty

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ascension All Saints Hospital, Inc

  • General Acute Care Hospital
  • Racine, WI
  • NPI 1639123284

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1194257154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE.",
            "address_2": "IM HOSPITALISTS STE 4206",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60201",
            "telephone_number": "847-570-1010",
            "fax_number": "847-733-5108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE.",
            "address_2": "IM HOSPITALISTS STE 4206",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60201",
            "telephone_number": "847-570-1010",
            "fax_number": "847-733-5108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3801 Spring St",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "WI",
            "postal_code": "534051667",
            "country_code": "US",
            "telephone_number": "262-687-4011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "420 DELAWARE ST SE",
            "address_2": "MMC 913",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554550341",
            "country_code": "US",
            "telephone_number": "612-624-0990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GODFREY",
        "first_name": "POLLY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-29",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036155636",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036155636",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": "WI",
            "license": "75605",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036155636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Scott Glick, D.D.S.
• Alison Glinski, PA-C
• Patrick Glista
• Catherine Gluck, PT
• Gnogno MD Visiting Physician Group Inc.
• Diane Christine Goebel, MD
• Joseph Golbus, M.D.
• Gold Coast Podiatry Center, LLC
• Kenneth N Goldberg, MD
• Lawrence Goldberg, MD

• All providers in Evanston, IL
• Hospitalist Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; 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.

Verify at the official NPI Registry.