Edgar Theodore Tumanguil Polintan, M.D.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

2023016707 Issued in MO

Practice address

6420 Clayton Road SSM Health St. Mary'S Hospital-St Lou
Department of Internal Medicine
St. Louis, MO 63117

Phone

(314) 768-8778

NPI assigned

Jun 29, 2023

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

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: epolinta455443@direct-ehr-ssmhc.com

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

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1477230670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6420 CLAYTON ROAD SSM HEALTH ST. MARY'S HOSPITAL-ST LOU",
            "address_2": "DEPARTMENT OF INTERNAL MEDICINE",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63117",
            "telephone_number": "314-768-8778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6420 CLAYTON ROAD SSM HEALTH ST. MARY'S HOSPITAL-ST LOU",
            "address_2": "DEPARTMENT OF INTERNAL MEDICINE",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63117",
            "telephone_number": "314-768-8778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLINTAN",
        "first_name": "EDGAR THEODORE",
        "middle_name": "TUMANGUIL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-29",
        "last_updated": "2023-12-27",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": "2023016707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI PHYSICIAN LICENSENUMBER",
            "identifier": "2023016707",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolyn Polakowski, MS, PLPC
• Diego Jose Polanco Pumarol, MD
• Kyle Polhemus, MD
• Laura Polhemus, MD
• Deepika Polineni, MD
• Gregory M Polites, MD
• Justin Christopher Polites, MD
• Kristen Emily Polito, PA-C
• Allison Politsch, DO
• Karen Politsch, LCSW

• Student in an Organized Health Care Education/Training Program in St. Louis, MO
• Providers in St. Louis, MO by specialty
• Student in an Organized Health Care Education/Training Program in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; 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.