NPIMap

Individual provider Active NPI

Paul Polyak, M.D.

  • Anesthesiology Physician
  • Philadelphia, PA
National Provider Identifier
1194905745
Registry record updated Apr 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD432748 Issued in PA
Practice address
111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824
Phone
(215) 955-6161
Fax
(215) 923-5507
NPI assigned
Nov 13, 2007
Last updated
Apr 23, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD432748 PA Primary

Addresses

Primary practice location

111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824

Mailing address

615 Chestnut St
14TH Floor
Philadelphia, PA 19106-4404

Other identifiers 2

IdentifierTypeStateIssuer
102144281MedicaidPA
0287512MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130913000600 MI Practitioner - Anesthesiology 0547346876 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Services Associates PCGroup PAC ID 4385557602, 67 clinicians

Practice addresses (Care Compare)

1101 W University Dr
Crittenton Hospital Medical Center
Rochester, MI 48307-1863
Phone (248) 652-5000

11800 E 12 Mile Rd
Warren, MI 48093-3472
Phone (586) 573-5000

1221 Pine Grove Ave
Port Huron, MI 48060-3511
Phone (810) 987-5000

1221 Pine GRV
Port Huron, MI 48060-3511

21510 Harrington St
Suite 300
Clinton Township, MI 48036-2378
Phone (586) 323-4575

2775 Blake Rd
Jackson, MI 49201-8838
Phone (517) 787-2906

401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Anesthesiology CurrentSince Jul 1, 2013 Accepting new patients
Lakeside Anesthesia Associates, PLLC Anesthesiology CurrentSince Dec 30, 2014 Accepting new patients
Henry Ford Health System Current Accepting new patients
Anesthesia Services Associates, PC Anesthesiology CurrentSince Sep 18, 2019 Accepting new patients
Grayling Anesthesia Associates PC Anesthesiology CurrentSince Mar 12, 2018 Accepting new patients
Henry Ford Health System CurrentSince Jul 1, 2013 Accepting new patients
Nazareth Hospital PastSince Jan 1, 1990 Accepting new patients
Nazareth Hospital PastSince Jan 1, 1990 Accepting new patients
Nazareth Hospital PastSince Jan 1, 1990 Accepting new patients
Nazareth Hospital PastSince Jan 1, 1990 Accepting new patients
Trinity Health Mid-Atlantic Medical Group PastSince Jan 1, 1990 Accepting new patients
Premier Anesthesia of Florida LLC Anesthesiology PastSince Jan 19, 2020 Accepting new patients

Locations

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

1100 E Michigan Ave
Grayling, MI 49738
Phone (989) 348-0317

2775 Blake Rd
Jackson, MI 49201
Phone (517) 787-2906

1000 Harrington St
Mount Clemens, MI 48043
Phone (586) 493-3727

432 W University Dr
Rochester, MI 48307
Phone (248) 651-6122

16001 W 9 Mile Rd
#601
Southfield, MI 48075
Phone (248) 424-3000

Interoperability endpoints

  • FHIR API: https://fhir.hfhs.org/FHIRProxy/api/FHIR/R4/

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335139200000",
    "number": "1194905745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 CHESTNUT ST",
            "address_2": "14TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191064404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 8490",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-6161",
            "fax_number": "215-923-5507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLYAK",
        "first_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-13",
        "last_updated": "2012-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD432748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102144281",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0287512",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.