Elena Poloukhine, MD
Individual provider Active NPI Gynecology Physician · Plainfield, CT
NPI 1487874483 · NPPES record last updated Jan 24, 2019
Key facts
- NPI
- 1487874483
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gynecology Physician 207VG0400X
- License
- 047206 (CT)
- Practice address
- 12 Lathrop Rd
Plainfield, CT 06374-2061 - Phone
- (860) 457-9209
- Fax
- (860) 457-9201
- NPI assigned
- May 1, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Rush Medical College of Rush University, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Day Kimball Medical Group Inc
Practice addresses (Care Compare)
132 Westminster Rd
Family Medicine Canterbury
Canterbury, CT 06331-1454
Phone (860) 546-2225
320 Pomfret St
Putnam, CT 06260-1836
Phone (860) 928-6541
Hospital & facility affiliations
- Day Kimball Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090416000372 | CT | Practitioner - Obstetrics/Gynecology | 6507839180 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047206 | CT | MD | Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Day Kimball Healthcare, Inc. | Current |
Accepting new patients | |
| Day Kimball Healthcare, Inc. | Current | Accepting new patients | |
| Day Kimball Medical Group Inc | Current |
Accepting new patients | |
| Day Kimball Healthcare, Inc. | Current |
Accepting new patients | |
| University Pathologists, LLC | Current | Accepting new patients | |
| University Plaza Obstetrics & Gynecology, LLP | Past | Accepting new patients |
Locations
132 Westminster Rd
Canterbury, CT 06331
Phone (860) 546-2225
612 Hartford Pike
Dayville, CT 06241
Phone (860) 779-0284
12 Lathrop Rd
Plainfield, CT 06374
Phone (860) 457-9150
320 Pomfret St
Putnam, CT 06260
Phone (860) 963-6331
340 Pomfret St
Putnam, CT 06260
Phone (860) 963-2242
Interoperability endpoints
- elena.poloukhine.1@1694.direct.athenahealth.com
- https://api.platform.athenahealth.com/1694/brand/19/csg/48/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 222823 | NY | |
| Gynecology Physician | 207VG0400X | 047206 | CT | Yes |
Addresses
Primary practice location
12 Lathrop Rd
Plainfield, CT 06374-2061
Mailing address
12 Lathrop Rd
Plainfield, CT 06374-2061
Phone (860) 457-9209
Other practice location 1
877 Stewart Ave
Suite 7
Garden City, NY 11530-4803
Phone (516) 222-0722
Other providers in Plainfield, CT
- Erica Joan Pelish-Sundstrom
- Plainfield Family Chiropractic, LLC
- Plainfield Public Schools
- Plainfield SNF Opco LLC
- Plainfield Walk in Medical Center LLC
- Premise Health of Connecticut Medical PC
- Quality Homemakers Ma, LLC
- Quality Homemakers, Inc
- Tucker William Romans
- Cherie A Sage
All providers in Plainfield, CT · Gynecology Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.