NPIMap

Individual provider Active NPI

Maria Victoria Polanco, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Shakopee, MN
National Provider Identifier
1467439455
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9327 Issued in MN
Practice address
1601 Saint Francis Ave Ste 100
Shakopee, MN 55379-3384
Phone
(952) 428-3535
Fax
(952) 428-3599
NPI assigned
Dec 29, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9327 MN Primary

Addresses

Primary practice location

1601 Saint Francis Ave Ste 100
Shakopee, MN 55379-3384

Mailing address

8170 33Rd Ave S # Ms 21110Q
Bloomington, MN 55425-4516

Other practice location 1

1415 Saint Francis Ave
Shakopee, MN 55379-3374
Phone (952) 993-7750

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mtenorio60534@excellian.direct.allina.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100122000339 MN Practitioner - Physician Assistant 9234271685 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

1451 Adams St S
Shakopee, MN 55379-2697
Phone (952) 428-4202

1601 Saint Francis Ave
Suite 100
Shakopee, MN 55379-3384
Phone (952) 428-3535

265 Creek LN S
Jordan, MN 55352-1214
Phone (952) 428-1200

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

6150 Egan Dr
Savage, MN 55378-2699
Phone (952) 428-3370

8170 Old Carriage CT
Suite 100
Shakopee, MN 55379-3164
Phone (952) 428-3600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
St. Francis Regional Medical Center CurrentSince Sep 22, 2025 Accepting new patients
Allina Health System CurrentSince Jan 27, 2025 Accepting new patients
Park Nicollet Clinic CurrentSince Jan 1, 1999 Accepting new patients
Allina Health System CurrentSince Jan 27, 2025 Accepting new patients
Allina Health System CurrentSince Jan 27, 2025 Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

265 Creek Ln S
Jordan, MN 55352
Phone (952) 428-1200

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

1415 Saint Francis Ave
Shakopee, MN 55379
Phone (952) 993-7750

1601 Saint Francis Ave
Ste 100
Shakopee, MN 55379
Phone (952) 403-3535

1455 Saint Francis Ave
Shakopee, MN 55379
Phone (952) 403-2200

Interoperability endpoints

  • Direct secure messaging: mtenorio60534@excellian.direct.allina.com

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 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1467439455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 SAINT FRANCIS AVE STE 100",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553793384",
            "telephone_number": "952-428-3535",
            "fax_number": "952-428-3599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1415 Saint Francis Ave",
            "address_purpose": "LOCATION",
            "city": "Shakopee",
            "state": "MN",
            "postal_code": "553793374",
            "country_code": "US",
            "telephone_number": "952-993-7750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLANCO",
        "first_name": "MARIA",
        "middle_name": "VICTORIA",
        "name_prefix": "Ms.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-29",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mtenorio60534@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "1601 Saint Francis Ave Ste 100",
            "city": "Shakopee",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553793384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Shakopee, MN

Sources for this page

Verify at the official NPI Registry.