Active NPI
Galina E Polevaya, PA-C
- Physician Assistant
- Springfield, IL
National Provider Identifier
1467791194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085-004595
- Practice address
- 800 N 1St St
Springfield, IL 62702-3719 - Phone
- (217) 528-7541
- Fax
- (217) 528-8962
- NPI assigned
- Jan 31, 2013
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085-004595 | IL | Primary |
Addresses
Primary practice location
800 N 1St St
Springfield, IL 62702-3719
Mailing address
1025 S 6TH St
Springfield, IL 62703-2403
Phone (217) 528-7541
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: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220321002268 | IL | Order and Referring Only - Physician Assistant | 6800031477 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52468 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446768000000",
"number": "1467791194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 S 6TH ST",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627032403",
"telephone_number": "217-528-7541",
"fax_number": "217-528-8962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 N 1ST ST",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627023719",
"telephone_number": "217-528-7541",
"fax_number": "217-528-8962"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLEVAYA",
"first_name": "GALINA",
"middle_name": "E",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-31",
"last_updated": "2015-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085-004595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2015; 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.