Active NPI
Joel Benjamin Polley, RN
- Registered Nurse
- Portland, OR
National Provider Identifier
1376811984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 201140650RN
- Practice address
- 3455 SW US Veterans Hospital Rd
Mail Code: SN-5N
Portland, OR 97239-3076 - Phone
- (503) 494-4537
- NPI assigned
- Dec 9, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 201140650RN | OR | Primary |
Addresses
Primary practice location
3455 SW US Veterans Hospital Rd
Mail Code: SN-5N
Portland, OR 97239-3076
Mailing address
3455 SW US Veterans Hospital Rd
Mail Code: SN-5N
Portland, OR 97239-3076
Phone (503) 494-4537
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1844 | Other | PIN |
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)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201140650RN | OR | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323388800000",
"number": "1376811984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3455 SW US VETERANS HOSPITAL RD",
"address_2": "MAIL CODE: SN-5N",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393076",
"telephone_number": "503-494-4537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3455 SW US VETERANS HOSPITAL RD",
"address_2": "MAIL CODE: SN-5N",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393076",
"telephone_number": "503-494-4537"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLEY",
"first_name": "JOEL",
"middle_name": "BENJAMIN",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-09",
"last_updated": "2011-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OR",
"license": "201140650RN",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PIN",
"identifier": "1844",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.