Thomas Michael Polidore, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

G83054 Issued in CA

Practice address

3 Medical Plaza Dr Ste 130
Roseville, CA 95661-3088

Phone

(916) 773-8750

Fax

(916) 797-4774

NPI assigned

Nov 17, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tpolidore112197@hisp.ehr.sutterhealth.org

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.

• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Palo Alto, CA
  • NPI 1013950807
  NPD (past)

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515628800000",
    "number": "1366424095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 MEDICAL PLAZA DR STE 130",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613088",
            "telephone_number": "916-773-8750",
            "fax_number": "916-797-4774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1225 Marshall St",
            "address_2": "#24",
            "address_purpose": "LOCATION",
            "city": "Crescent City",
            "state": "CA",
            "postal_code": "955312281",
            "country_code": "US",
            "telephone_number": "707-465-0884",
            "fax_number": "707-465-8356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLIDORE",
        "first_name": "THOMAS",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2018-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "CA",
            "license": "G83054",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "G83054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOG830540",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corrina Michele Pochini
• Keira Ryan Poetsch
• Kristin Pohl
• Lisa A Pohlman
• Sabina Pokorney, NP
• Erik Polik, DO
• Anna Polishchuk, FNP
• Carley Pollack
• Polyakova Incorporated
• Morghan Pomeroy

• Surgery Physician in Roseville, CA
• Providers in Roseville, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.