Active NPI
Scott Polivka
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Lansing, MI
National Provider Identifier
1477190270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 5302036186
- Practice address
- 921 W Holmes Rd
Lansing, MI 48910-0439 - Phone
- (517) 393-7009
- NPI assigned
- Nov 30, 2019
- Last updated
- Nov 30, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 5302036186 | MI | Primary |
Addresses
Primary practice location
921 W Holmes Rd
Lansing, MI 48910-0439
Mailing address
900 Long Blvd Apt 214
Lansing, MI 48911-6705
Phone (517) 275-2871
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302036186 | MI | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Co of Michigan | Past | Accepting new patients | |
| Kroger Co of Michigan | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575072000000",
"number": "1477190270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 LONG BLVD APT 214",
"city": "LANSING",
"state": "MI",
"postal_code": "489116705",
"telephone_number": "517-275-2871"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "921 W HOLMES RD",
"city": "LANSING",
"state": "MI",
"postal_code": "489100439",
"telephone_number": "517-393-7009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLIVKA",
"first_name": "SCOTT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-11-30",
"last_updated": "2019-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "MI",
"license": "5302036186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lansing, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.