Active NPI
Polly Foreman, MD
- Anesthesiology Physician
- Elizabethtown, KY
National Provider Identifier
1487659215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 30369
- Practice address
- 639 N Mulberry St
Elizabethtown, KY 42701-1931 - Phone
- (270) 737-4600
- Fax
- (270) 737-1722
- NPI assigned
- Jun 17, 2005
- Last updated
- Mar 19, 2008
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 30369 | KY | Primary |
Addresses
Primary practice location
639 N Mulberry St
Elizabethtown, KY 42701-1931
Mailing address
639 N Mulberry St
Elizabethtown, KY 42701-1931
Phone (270) 737-4600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64303696 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205884800000",
"number": "1487659215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "639 N MULBERRY ST",
"city": "ELIZABETHTOWN",
"state": "KY",
"postal_code": "427011931",
"telephone_number": "270-737-4600",
"fax_number": "270-737-1722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "639 N MULBERRY ST",
"city": "ELIZABETHTOWN",
"state": "KY",
"postal_code": "427011931",
"telephone_number": "270-737-4600",
"fax_number": "270-737-1722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOREMAN",
"first_name": "POLLY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-17",
"last_updated": "2008-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "KY",
"license": "30369",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64303696",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elizabethtown, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; 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.