NPIMap

Individual provider Active NPI

Mayra Ivelisse Cruz Polanco, M.D

  • Internal Medicine Physician
  • Jamaica Plain, MA
National Provider Identifier
1194913012
Registry record updated Nov 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
235402 Issued in MA
Practice address
545A Centre St
Jamaica Plain, MA 02130-2061
Phone
(617) 522-5464
Fax
(617) 524-2966
NPI assigned
Oct 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 235402 MA Primary

Addresses

Primary practice location

545A Centre St
Jamaica Plain, MA 02130-2061

Mailing address

545A Centre St
Jamaica Plain, MA 02130-2061
Phone (617) 522-5464

Other identifiers 1

IdentifierTypeStateIssuer
2156318MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20080908000161 MA Practitioner - Internal MedicinePractitioner - Geriatric Medicine 9830265339 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Beth Israel Deaconess Medical Center IncGroup PAC ID 8123936119, 136 clinicians
Medical Care of Boston Management CorporationGroup PAC ID 6800787714, 293 clinicians

Practice addresses (Care Compare)

330 Brookline Ave
Boston, MA 02215-5400
Phone (617) 667-2000

93 Pond St
Sharon, MA 02067-2015
Phone (781) 784-9212

Hospital & facility affiliations

  • Hebrew Seniorlife - Home Health Care Home health agency, Dedham, MA, CCN 227422
  • Pathways Healthcare Home health agency, Westwood, MA, CCN 227569
  • Bayada Home Health Care, Inc Home health agency, Canton, MA, CCN 227551
  • Beth Israel Deaconess Medical Center Hospital, Boston, MA, CCN 220086
  • Brigham and Women Faulkner Hospital Hospital, Jamaica Plain, MA, CCN 220119
  • Beth Israel Deaconess Hospital - Needham Hospital, Needham, MA, CCN 220083
  • Hebrew Rehabilitation Center Long-term care hospital, Boston, MA, CCN 222007

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Care of Boston Management Corporation Internal Medicine CurrentSince Jun 1, 2009 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Oct 20, 2011 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Oct 20, 2011 Accepting new patients
Icahn School of Medicine at Mount Sinai Internal Medicine Past Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

545A Centre St
Jamaica Plain, MA 02130
Phone (617) 522-5464

3525 Washington St
Ste 100
Jamaica Plain, MA 02130
Phone (617) 263-7555

93 Pond St
Sharon, MA 02067
Phone (781) 784-9212

Interoperability endpoints

  • Direct secure messaging: mcruzpolanco253786@direct.bilh.masshiway.net

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227657600000",
    "number": "1194913012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545A CENTRE ST",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021302061",
            "telephone_number": "617-522-5464",
            "fax_number": "617-524-2966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545A CENTRE ST",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021302061",
            "telephone_number": "617-522-5464",
            "fax_number": "617-524-2966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ POLANCO",
        "first_name": "MAYRA",
        "middle_name": "IVELISSE",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-04",
        "last_updated": "2008-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "235402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2156318",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica Plain, MA

Sources for this page

Verify at the official NPI Registry.