NPIMap

Individual provider Active NPI

Polina Makedonsky, NP-C

  • Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1396106399
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95004009 Issued in CA
Practice address
4077 Fifth Ave
San Diego, CA 92103-2105
Phone
(619) 294-8111
NPI assigned
Mar 18, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95004009 CA Primary

Addresses

Primary practice location

4077 Fifth Ave
San Diego, CA 92103-2105

Mailing address

6454 Panel CT
San Diego, CA 92122-3007
Phone (619) 319-0252

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161010001035 CA Practitioner - Nurse Practitioner 7214225135 Reassigns benefits to 4 organizations
I20240529000515 TX Practitioner - Nurse Practitioner 7214225135 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Texas Southwestern Medical Center at DallasGroup PAC ID 0648188250, 3,156 clinicians

Practice addresses (Care Compare)

5200 Harry Hines Blvd
Dallas, TX 75235-7709
Phone (214) 590-8000

Hospital & facility affiliations

  • Parkland Health & Hospital System Hospital, Dallas, TX, CCN 450015

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
95004009CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 23, 2017 Accepting new patients
Emergency Services Medical Corporation Coronado CurrentSince Aug 1, 2020 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Emergency Services Medical Corporation CurrentSince Jan 5, 2020 Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Aug 5, 2024 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Aug 5, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 23, 2017 Accepting new patients
Pacific Emergency Providers, a Prof. Corp. CurrentSince Aug 7, 2016 Accepting new patients

Locations

1240 Broadway
Chula Vista, CA 91911
Phone (619) 213-0000

4760 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 783-0567

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

250 Prospect Pl
San Diego, CA 92118
Phone (619) 522-3600

4077 5th Ave
#M
San Diego, CA 92103
Phone (619) 260-7000

4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245

1751 University Dr
Vista, CA 92083
Phone (760) 208-6000

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Organizations & group practices 9

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.

Hospital & facility affiliations 45

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1458259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1396106399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6454 PANEL CT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921223007",
            "telephone_number": "619-319-0252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 FIFTH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032105",
            "telephone_number": "619-294-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAKEDONSKY",
        "first_name": "POLINA",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-18",
        "last_updated": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95004009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4760 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.