NPIMap

Individual provider Active NPI

Staci Ernandez Polk, PA-C

  • Physician Assistant
  • Lancaster, SC
National Provider Identifier
1245861236
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3508 Issued in SC
Practice address
834 W Meeting St Ste E
Lancaster, SC 29720-6220
Phone
(803) 285-5900
NPI assigned
Jan 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3508 SC Primary

Addresses

Primary practice location

834 W Meeting St Ste E
Lancaster, SC 29720-6220

Mailing address

PO Box 23467
New York, NY 10087-3467
Phone (843) 792-6200

Other practice location 1

2753 Fire Tower Rd
Rock Hill, SC 29730-9008
Phone (803) 209-0945

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Direct@direct.musc.edu Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20230110000731 SC Practitioner - Physician Assistant 2365812286 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

1 Medical Park Dr
Chester, SC 29706-9769

506 N St
Bamberg, SC 29003-1319
Phone (803) 245-6290

834 W Meeting St
Lancaster, SC 29720-6220

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3508SCMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Mar 1, 2025 Accepting new patients
Musc Community Physicians CurrentSince Mar 1, 2025 Accepting new patients
Medical University Hospital Authority CurrentSince Dec 14, 2022 Accepting new patients
Medical University Hospital Authority CurrentSince Dec 14, 2022 Accepting new patients
Medical University Hospital Authority Past Accepting new patients
Medical University Hospital Authority Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

834 W Meeting St
Ste A
Lancaster, SC 29720
Phone (803) 285-1411

834 W Meeting St
Ste E
Lancaster, SC 29720
Phone (803) 283-3775

511 S Main St
Mullins, SC 29574
Phone (843) 464-8244

Interoperability endpoints

  • Direct secure messaging: spolk416533@direct.musc.edu

Organizations & group practices 6

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 6

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": "1580256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1245861236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23467",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873467",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 W MEETING ST STE E",
            "city": "LANCASTER",
            "state": "SC",
            "postal_code": "297206220",
            "telephone_number": "803-285-5900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2753 Fire Tower Rd",
            "address_purpose": "LOCATION",
            "city": "Rock Hill",
            "state": "SC",
            "postal_code": "297309008",
            "country_code": "US",
            "telephone_number": "803-209-0945",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLK",
        "first_name": "STACI",
        "middle_name": "ERNANDEZ",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-29",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Direct@direct.musc.edu",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "834 W Meeting St Ste E",
            "city": "Lancaster",
            "state": "SC",
            "country_code": "US",
            "postal_code": "297206220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lancaster, SC

Sources for this page

Verify at the official NPI Registry.