Mary Elizabeth Polhamus, RD

Primary specialty

Nutrition Education NutritionistTaxonomy code 133NN1002X

License

DI60752527 Issued in WA

Practice address

24060 SE Kent Kangley Rd Ste D100
Maple Valley, WA 98038-6851

Phone

(425) 690-3522

Fax

(425) 690-9522

NPI assigned

Aug 15, 2017

Last updated

Oct 2, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mary Elizabeth Walton Former name

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley Medical Group-RentonGroup PAC ID 4183753965, 419 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Valley Medical Group-Renton

  • General Acute Care Hospital
  • Renton, WA
  • NPI 1619209574
  Medicare reassignment Care Compare group NPD
• Public Hospital District #1 of King County

  dba VMC Children's Therapy

  • Rehabilitation Hospital Unit
  • Renton, WA
  • NPI 1811063308
  NPD (past)

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1336665959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34876",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241876",
            "telephone_number": "425-690-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24060 SE KENT KANGLEY RD STE D100",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980386851",
            "telephone_number": "425-690-3522",
            "fax_number": "425-690-9522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLHAMUS",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-15",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "WA",
            "license": "DI60752527",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI60752527",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "WALTON",
            "middle_name": "ELIZABETH",
            "credential": "RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Nutrition Education Nutritionist in Maple Valley, WA
• Providers in Maple Valley, WA by specialty
• Nutrition Education Nutritionist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.