Active NPI
Marshall Polakoff, PSYD
- Psychologist
- Ottawa, IL
National Provider Identifier
1437237443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 2590 Covel Bluff Rd
Ottawa, IL 61350-9260 - Phone
- (815) 434-0806
- Fax
- (815) 434-0806
- NPI assigned
- Nov 1, 2006
- Last updated
- Aug 14, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
2590 Covel Bluff Rd
Ottawa, IL 61350-9260
Mailing address
PO Box 2102
Ottawa, IL 61350
Phone (815) 434-0806
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040505001290 | IL | Practitioner - Clinical Psychologist | 7719975846 | Practice locations: Ottawa, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2590 Covel Bluff Rd
Ottawa, IL 61350-9260
Phone (815) 434-0806
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344902400000",
"number": "1437237443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2102",
"city": "OTTAWA",
"state": "IL",
"postal_code": "61350",
"telephone_number": "815-434-0806",
"fax_number": "815-434-0806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2590 COVEL BLUFF RD",
"city": "OTTAWA",
"state": "IL",
"postal_code": "613509260",
"telephone_number": "815-434-0806",
"fax_number": "815-434-0806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLAKOFF",
"first_name": "MARSHALL",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2012-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ottawa, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; 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.