Individual provider Active NPI

Maxim Alexandrovich Polansky, M.D.

  • MOHS-Micrographic Surgery Physician
  • Chicago, IL
National Provider Identifier
1275913006
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
036159949 Issued in IL
Practice address
1725 W Harrison St Ste 264
Chicago, IL 60612-3844
Phone
(312) 942-2195
NPI assigned
Jun 6, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X 73235 WI
MOHS-Micrographic Surgery Physician 207ND0101X 036159949 IL Primary

Addresses

Primary practice location

1725 W Harrison St Ste 264
Chicago, IL 60612-3844

Mailing address

1725 W Harrison St Ste 264
Chicago, IL 60612-3844
Phone (312) 942-2195

Other practice location 1

789 Howard Ave
YNHH PCC York St. Campus
New Haven, CT 06519-1304
Phone (203) 688-8300

Other practice location 2

1000 N Oak Ave
Marshfield, WI 54449-5703
Phone (715) 387-5511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL, NC3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20200708003386 WI Practitioner - Micrographic Dermatologic Surgery (MDS)Practitioner - Dermatology 6406161215 Reassigns benefits to 2 organizations
I20220728000751 IL Practitioner - Dermatology 6406161215 Reassigns benefits to 2 organizations
I20230901002587 NC Practitioner - Micrographic Dermatologic Surgery (MDS) 6406161215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Texas Medical School at Houston, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pinnacle Dermatology SCGroup PAC ID 8628353380, 145 clinicians
Skin Surgery Center PAGroup PAC ID 3173599479, 72 clinicians

Practice addresses (Care Compare)

1124 Essington Rd
Suite a
Joliet, IL 60435-8442
Phone (815) 744-8554

701 E Roosevelt Blvd
Suite 200a
Monroe, NC 28112-4139
Phone (704) 289-9448

Hospital & facility affiliations

  • Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062

Merit-based Incentive Payment System (MIPS)

Final score
90.65 of 100Reported as group
Promoting interoperability
89
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
89.8 of 100Reported as group
Promoting interoperability
88
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision447
Removal of skin lesions828
Removal of skin cancer1461
Removal or shaving of skin growth61
Skin biopsy574

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036159949ILMDMOHS-Micrographic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Skin Surgery Center PA Mohs-Micrographic Surgery CurrentSince Oct 1, 2023 Accepting new patients
Rush University Medical Group CurrentSince Jul 1, 2022 Accepting new patients
MCHS Hospitals Inc Current Accepting new patients
Skin Surgery Center PA CurrentSince Oct 1, 2023 Accepting new patients
MCHS Hospitals Inc CurrentSince Jul 6, 2020 Accepting new patients
Marshfield Clinic Inc CurrentSince Jul 6, 2020 Accepting new patients
MCHS Hospitals Inc CurrentSince Jul 6, 2020 Accepting new patients
Pinnacle Dermatology, SC Mohs-Micrographic Surgery CurrentSince Dec 1, 2022 Accepting new patients

Locations

75 Remittance Dr
Dept 1611
Chicago, IL 60675

2148 N Damen Ave
Chicago, IL 60647
Phone (773) 938-8128

1725 W Harrison St
Ste 264
Chicago, IL 60612
Phone (312) 942-2195

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

606 W Pershing Rd
Decatur, IL 62526
Phone (217) 877-7171

2500 W Higgins Rd
Ste 1040
Hoffman Estates, IL 60169
Phone (847) 884-8096

1124 Essington Rd
Joliet, IL 60435
Phone (815) 373-1004

1124 Essington Rd
Ste A
Joliet, IL 60435

820 Springer Dr
Lombard, IL 60148
Phone (708) 634-4602

1870 Silver Cross Blvd
Ste 250
New Lenox, IL 60451
Phone (815) 462-3474

10720 165th St
Orland Park, IL 60467
Phone (708) 460-7890

123 W Michigan St
Ottawa, IL 61350
Phone (815) 431-9850

701 E Roosevelt Blvd
Ste 200A
Monroe, NC 28112
Phone (704) 282-8276

1450 Professional Park Dr
Winston Salem, NC 27103
Phone (336) 724-2434

1450 Professional Park Dr
Ste 150
Winston Salem, NC 27103
Phone (336) 724-2434

1000 Starr Ave
Eau Claire, WI 54703
Phone (715) 858-4850

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

Interoperability endpoints

  • Direct secure messaging: maxim.polansky@qdp.emadirect.md
  • Direct secure messaging: maxim.polansky@marshfieldclinichealthsystem.cernerdirect.com

Organizations & group practices 8

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 2

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": "1433548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1275913006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 W HARRISON ST STE 264",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123844",
            "telephone_number": "312-942-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 W HARRISON ST STE 264",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123844",
            "telephone_number": "312-942-2195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "789 Howard Ave",
            "address_2": "YNHH PCC York St. Campus",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065191304",
            "country_code": "US",
            "telephone_number": "203-688-8300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 N Oak Ave",
            "address_purpose": "LOCATION",
            "city": "Marshfield",
            "state": "WI",
            "postal_code": "544495703",
            "country_code": "US",
            "telephone_number": "715-387-5511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLANSKY",
        "first_name": "MAXIM",
        "middle_name": "ALEXANDROVICH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-06",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "WI",
            "license": "73235",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IL",
            "license": "036159949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.