Active NPI
Mark D Poloway, PH.D.
- Clinical Psychologist
- Oceanside, CA
National Provider Identifier
1457438624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY8883
- Practice address
- 2181 El Camino Real
Suite 205
Oceanside, CA 92054-6222 - Phone
- (760) 612-5490
- Fax
- (760) 859-3002
- NPI assigned
- Nov 1, 2006
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY8883 | CA | Primary |
Addresses
Primary practice location
2181 El Camino Real
Suite 205
Oceanside, CA 92054-6222
Mailing address
4006 Isle Dr
Carlsbad, CA 92008-3615
Phone (760) 612-5490
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PK00088830 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20120306000307 | CA | Practitioner - Clinical Psychologist | 6608035985 | Practice locations: Carlsbad, CA; Oceanside, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
2181 S El Camino Real
Suite 205
Oceanside, CA 92054-6222
Phone (760) 612-5490
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8883 | CA | MD | Addiction (Substance Use Disorder) Counselor |
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": "1482883200000",
"number": "1457438624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4006 ISLE DR",
"city": "CARLSBAD",
"state": "CA",
"postal_code": "920083615",
"telephone_number": "760-612-5490",
"fax_number": "760-859-3002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2181 EL CAMINO REAL",
"address_2": "SUITE 205",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920546222",
"telephone_number": "760-612-5490",
"fax_number": "760-859-3002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLOWAY",
"first_name": "MARK",
"middle_name": "D",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2016-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY8883",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PK00088830",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oceanside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; 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.