Mark J Polak, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

13579 Issued in WV

Practice address

1 Stadium Drive
Morgantown, WV 26506

Phone

(304) 598-4800

Fax

(304) 598-6873

NPI assigned

Oct 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WV, PA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St Josephs Hospital of Buckhannon Inc

  • Critical Access Hospital
  • Buckhannon, WV
  • NPI 1124005061
  Medicare reassignment NPD
• University Healthcare Physicians, Inc.

  • Family Medicine Physician
  • Martinsburg, WV
  • NPI 1659625739

  Pediatrics

  Medicare reassignment NPD
• West Virginia University Medical Corporation

  • Family Medicine Physician
  • Morgantown, WV
  • NPI 1275504508

  Pediatrics

  Medicare reassignment NPD
• Wheeling Hospital Inc

  • Family Medicine Physician
  • Wheeling, WV
  • NPI 1548923923
  Medicare reassignment NPD
• Fayette Physician Network Inc

  • Surgery Physician
  • Uniontown, PA
  • NPI 1992107817

  Pediatrics

  Medicare reassignment NPD
• Reynolds Memorial Hospital, Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Glen Dale, WV
  • NPI 1518068014
  Medicare reassignment
• Health and Education Building

  • Student Health Clinic/Center
  • Morgantown, WV
  • NPI 1174803027
  NPD
• Reynolds Memorial Hospital Inc

  • Surgery Physician
  • Wheeling, WV
  • NPI 1457657991
  NPD
• University Healthcare Physicians Inc

  • Anesthesiology Physician
  • Martinsburg, WV
  • NPI 1417371329
  NPD
• West Virginia University Medical Corporation

  • Community/Behavioral Health Agency
  • Martinsburg, WV
  • NPI 1174233530
  NPD
• Fayette Physician Network Inc

  • Family Medicine Physician
  • Friendsville, MD
  • NPI 1437823044
  NPD
• Monongalia County General Hospital Company

  • General Acute Care Hospital
  • Morgantown, WV
  • NPI 1659489631
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1265512255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 897",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265070897",
            "telephone_number": "304-293-7401",
            "fax_number": "304-293-6963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 STADIUM DRIVE",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "26506",
            "telephone_number": "304-598-4800",
            "fax_number": "304-598-6873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLAK",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "13579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0105897000",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpolak657@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1 Medical Center Dr",
            "city": "Morgantown",
            "state": "WV",
            "country_code": "US",
            "postal_code": "265061200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Point of Freedom Counseling
• Sushil Pokharel, MD
• Carmella Polak, LPC
• Erin Marie Polak, CPNP-PC
• Judith Polak, CNNP
• Tejasri Polana, MBBS
• Jennifer Lynn Poland, MS,CCC/SLP
• Kathryn Poland
• Lisa Ann Poland
• Brittany Rachelle Poletti, RN, CRNA

• Pediatrics Physician in Morgantown, WV
• Providers in Morgantown, WV by specialty
• Pediatrics Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.