Shannon Polley

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

60864 Issued in CA

Practice address

765 Medical Center CT Ste 211
Chula Vista, CA 91911-6600

Phone

(617) 636-0405

NPI assigned

Jun 28, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Tufts University School of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Health Centers of San Diego IncGroup PAC ID 3476446378, 299 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sharp Chula Vista Medical Center Hospital, Chula Vista, CA, CCN 050222

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: spolley590127@direct.ochin.org

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.

• Family Health Centers of San Diego, Inc

  dba Logan Heights Family Health Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1447281936
  Medicare reassignment Care Compare group
• Family Health Centers of San Diego Inc

  dba Beach Area Family Health Center Annex

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1184982159
  NPD
• Family Health Centers of San Diego, Inc

  dba Escondido Physical Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Escondido, CA
  • NPI 1356178180
  NPD

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

• Sharp Chula Vista Medical Center

  • General Acute Care Hospital
  • Chula Vista, CA
  • NPI 1396728630
  Care Compare affiliation

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1225608722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 MEDICAL CENTER CT STE 211",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919116600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 MEDICAL CENTER CT STE 211",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919116600",
            "telephone_number": "617-636-0405"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4725 Market St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921024715",
            "country_code": "US",
            "telephone_number": "619-515-2560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLLEY",
        "first_name": "SHANNON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-28",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "60864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ana Valeria Poggio, D.D.S.
• Ashunty Alise Pointe
• Paloma Anais Polanco Figueroa
• Leticia A. Polanco, M.D.
• Tracy L. Polanco, M.D.
• Rebecca Ines Ponce
• Sara R Ponce, FNP-BC
• Sonia Gabriela Ponce, MD
• Mauricio Edgardo Pons, M.D
• Edith Pont

• Physician Assistant in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.