NPIMap

Individual provider Active NPI

Amanda Polacco, OD

  • Optometrist
  • Houston, TX
National Provider Identifier
1316464134
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10375 Issued in TX
Practice address
4401 Martin Luther King Blvd
Houston, TX 77204-2020
Phone
(713) 743-2020
Fax
(713) 743-0963
NPI assigned
Aug 23, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 008677 NY
Optometrist 152W00000X 10375 TX Primary

Addresses

Primary practice location

4401 Martin Luther King Blvd
Houston, TX 77204-2020

Mailing address

4401 Martin Luther King Blvd.
Houston, TX 77204-2020
Phone (713) 743-2020

Other practice location 1

33 W 42nd St
New York, NY 10036-8005
Phone (212) 938-4000

Other identifiers 2

IdentifierTypeStateIssuer
00244528MedicaidNY
429762401MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211014002425 TX Practitioner - Optometry 5092081984 Reassigns benefits to 1 organization
I20231129000969 MT Practitioner - Optometry 5092081984 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Billings ClinicGroup PAC ID 6002993516, 814 clinicians

Practice addresses (Care Compare)

801 N 29TH St
Billings, MT 59101-0905
Phone (406) 238-2500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10375TXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Billings Clinic Optometrist CurrentSince Dec 1, 2023 Accepting new patients
Billings Clinic Current Accepting new patients
University of Houston System CurrentSince Oct 7, 2021 Accepting new patients
Billings Clinic Current Accepting new patients
University of Houston CurrentSince Oct 7, 2021 Accepting new patients
Billings Clinic CurrentSince Dec 1, 2023 Accepting new patients
University of Houston System Optometrist Current Accepting new patients

Locations

801 N 29th St
Billings, MT 59101
Phone (406) 238-2210

2800 10th Ave N
Billings, MT 59101
Phone (406) 248-3290

190 Heights Blvd
Houston, TX 77007
Phone (713) 527-8480

4901 Calhoun Rd
Houston, TX 77204
Phone (713) 743-1921

4401 Martin Luther King Blvd
Houston, TX 77204
Phone (713) 743-1921

Interoperability endpoints

  • Direct secure messaging: apolacco@billingsclinic.cernerdirect.com

Organizations & group practices 7

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 10

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": "1503446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652313600000",
    "number": "1316464134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 MARTIN LUTHER KING BLVD.",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772042020",
            "telephone_number": "713-743-2020",
            "fax_number": "713-743-0963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 MARTIN LUTHER KING BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772042020",
            "telephone_number": "713-743-2020",
            "fax_number": "713-743-0963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "33 W 42nd St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100368005",
            "country_code": "US",
            "telephone_number": "212-938-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLACCO",
        "first_name": "AMANDA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-23",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "008677",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "10375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00244528",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429762401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.