Active NPI
Eufemio Contreras Polanco, PHYSICIAN ASSISTANT
- Physician Assistant
- Buckeye, AZ
National Provider Identifier
1346464195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1426
- Practice address
- 1209 N Miller Rd
Buckeye, AZ 85326-1043 - Phone
- (623) 386-5785
- Fax
- (623) 386-6673
- NPI assigned
- Apr 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1426 | AZ | Primary |
Addresses
Primary practice location
1209 N Miller Rd
Buckeye, AZ 85326-1043
Mailing address
9250 N 3Rd St
Suite 4010
Phoenix, AZ 85020-2437
Phone (602) 633-3848
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 86-0783428 | Other | AZ | TAX-ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Medical Group Arizona, LLC | Past | Accepting new patients | |
| Privia Medical Group Arizona, LLC | Past | Accepting new patients | |
| Emergency Physicians Professional Association LTD | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Emergency Medicine Physician
- Phoenix, AZ
- NPI 1114931490
-
- Family Medicine Physician
- Payson, AZ
- NPI 1740459700
-
- Family Medicine Physician
- Phoenix, AZ
- NPI 1760441141
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343779200000",
"number": "1346464195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9250 N 3RD ST",
"address_2": "SUITE 4010",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850202437",
"telephone_number": "602-633-3848",
"fax_number": "602-633-3841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1209 N MILLER RD",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853261043",
"telephone_number": "623-386-5785",
"fax_number": "623-386-6673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLANCO",
"first_name": "EUFEMIO",
"middle_name": "CONTRERAS",
"name_prefix": "Mr.",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-12",
"last_updated": "2012-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "1426",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX-ID",
"identifier": "86-0783428",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buckeye, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.