John William Polley, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

4301403808 Issued in MI

Practice address

5085 Anna Dr Ste a
Traverse City, MI 49684-7475

Phone

(231) 935-0180

Fax

(231) 935-0099

NPI assigned

Nov 10, 2005

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 3

Other names 1

• Dr. John William Polley Professional name

Medicare fee-for-service enrollment

Enrolled in MI

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

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jpolley110452@epic00.shdirect.org
• Direct secure messaging: jpolley@directaddress.net

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.

• Munson Medical Center

  • Endocrinology, Diabetes & Metabolism Physician
  • Traverse City, MI
  • NPI 1083761860

  MI

  Medicare reassignment NPD
• Munson Medical Center

  • Psychiatric Hospital Unit
  • Traverse City, MI
  • NPI 1891586103
  NPD
• Munson Medical Center

  • Plastic Surgery Physician
  • Traverse City, MI
  • NPI 1992463566

  Plastic Surgery

  NPD
• Munson Medical Center

  • Family Medicine Physician
  • Traverse City, MI
  • NPI 1881623031
  NPD (past)

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1477534931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5085 ANNA DR STE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847475",
            "telephone_number": "231-935-0180",
            "fax_number": "231-935-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5085 ANNA DR STE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847475",
            "telephone_number": "231-935-0180",
            "fax_number": "231-935-0099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "35 Michigan St NE Ste 5201",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495032514",
            "country_code": "US",
            "telephone_number": "616-486-5885",
            "fax_number": "616-391-1191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLLEY",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2023-03-07",
        "certification_date": "2022-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MI",
            "license": "4301403808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036079739",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMI",
            "identifier": "0B80405",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "21623004",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "POLLEY",
            "middle_name": "WILLIAM",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Merita Frances Pohlman, LLBSW
• Deborah Anne Poineau, LMSW
• Sydney Poineau, LMSW
• Jennifer Polanic, MD
• Jessica Pollard, DO
• Jill Norene Polmateer, N.P.
• Mark R. Pomaranski, M.D.
• Laura Elizabeth Pond, DNP, PMHNP-BC
• David L Pontious, R.PH.
• Marshall Thomas Poole, D.O.

• Plastic Surgery Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Plastic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.