Mark R Polak, D.O.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

0101050212 Issued in VA

Practice address

601 Childrens LN
Norfolk, VA 23507-1910

Phone

(757) 668-7320

Fax

(757) 668-9735

NPI assigned

Jun 7, 2006

Last updated

Jan 15, 2010By the provider in NPPES

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 6

Medicare fee-for-service enrollment

Enrolled in VA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

• Childrens Specialty Group PLLC

  • Pediatrics Physician
  • Norfolk, VA
  • NPI 1255354130
  Medicare reassignment NPD

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263513600000",
    "number": "1356381412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 79137",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212790137",
            "telephone_number": "757-668-7200",
            "fax_number": "757-668-9691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 CHILDRENS LN",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071910",
            "telephone_number": "757-668-7320",
            "fax_number": "757-668-9735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLAK",
        "first_name": "MARK",
        "middle_name": "R",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2010-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0101050212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "690567T",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005713668",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017337390001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "732002700",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9840896000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000980903",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• PNMC
• Keysha Ann Pochopien, AHCNS-BC
• Podiatry Home Care LLC
• Michael P Poirier, M.D.
• Melissa G Pola, AUD
• Polaris Pharmacy Services of Virginia LLC
• Michael Henryk Polchert, MD
• Gloria Robin Polite, LPC
• Christine Yejin Polizzi, DO
• Dennis Michael Polli, IDC

• Anesthesiology Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Anesthesiology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2010; 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.