Samuel William Polen, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

012753 Issued in SC

Practice address

1315 Roberts St
Camden, SC 29020-3737

Phone

(803) 713-6140

NPI assigned

Jun 24, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• E Jackson St Emergency Physicians LLC

  • Emergency Medicine Physician
  • Dillon, SC
  • NPI 1932398773
  NPD (past)
• McLeod Regional Medical Center of the Pee Dee, Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Florence, SC
  • NPI 1154371433

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206662400000",
    "number": "1194721076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PEE DEE DR",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295018279",
            "telephone_number": "843-661-5061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 ROBERTS ST",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290203737",
            "telephone_number": "803-713-6140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLEN",
        "first_name": "SAMUEL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-24",
        "last_updated": "2008-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "012753",
            "primary": true
        },
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "SC",
            "license": "012753",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "012753",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127534",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eugene Pickard
• Stephen Michael Pillinger, DO
• Jeffrey Pires Jr., PHARM.D.
• James Byron Plummer, DDS
• Ashlynn Plyler
• Debra Caprice Poore
• Artralia Portee
• Meagan Kathleen Powell
• Angela Nicole Powers, MA
• Christian Kilman Pratt

• Emergency Medicine Physician in Camden, SC
• Providers in Camden, SC by specialty
• Emergency Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.