Polly M Sepulvado, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD16468 Issued in OR

Practice address

150 NE Kenneth Ford Dr
Roseburg, OR 97470-1042

Phone

(416) 729-5965

Fax

(541) 492-2060

NPI assigned

Nov 3, 2005

Sex

Female

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

Enrolled in OR

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

Merit-based Incentive Payment System (MIPS)

Final score

93.78 of 100Reported as apm

Quality

80.38

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
  • NPI 1396751772
  Medicare reassignment NPD
• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Glide, OR
  • NPI 1609065010
  NPD
• Umpqua Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Roseburg, OR
  • NPI 1720803810
  NPD

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1366433781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "573 NE STEPHENS ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703150",
            "telephone_number": "541-677-2432",
            "fax_number": "541-957-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 NE KENNETH FORD DR",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974701042",
            "telephone_number": "416-729-5965",
            "fax_number": "541-492-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEPULVADO",
        "first_name": "POLLY",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-03",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "OR",
            "license": "MD16468",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD16468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005129",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ann R Sedlacek, PMHNP
• Bradley H Seely, MD
• David G Seibel, DO
• Mary Lee Seidler, RN
• Mary Selken, CADC
• Serenity Lane
• Kenneth Edward Serkownek, PHD
• Erin Suzanne Severson-Hobson, RPH
• Kimberly Sewell
• Linda L Sewell, MD

• Internal Medicine Physician in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; 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.
• 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.