Jay Howard Polokoff, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

026051 Issued in GA

Practice address

455 Philip Blvd, Suite 130
Kaiser Permanente Lawrenceville Medical Center
Lawrenceville, GA 30046

Phone

(678) 985-5006

Fax

(770) 449-9319

NPI assigned

Apr 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Pediatrics

  Medicare reassignment NPD

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335398400000",
    "number": "1467415281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT ROAD, NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30305",
            "telephone_number": "404-364-7070",
            "fax_number": "770-449-9319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 PHILIP BLVD, SUITE 130",
            "address_2": "KAISER PERMANENTE LAWRENCEVILLE MEDICAL CENTER",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30046",
            "telephone_number": "678-985-5006",
            "fax_number": "770-449-9319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLOKOFF",
        "first_name": "JAY",
        "middle_name": "HOWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2012-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "026051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000338511B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Pohl, RDN
• Donald E Poland, M.D.
• Ervin Polite
• Latoya Nichole Polk, LPC
• Darling Kariso Pollyn-Hill
• Kwanika Pomales
• Chelsa Ponder, OTR/L
• Nadege Laure Pone, NP
• Katherine Laoni Ponsoldt, LMSW
• Kristina Poole, DPT

• Pediatrics Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.