Clinton D. Polhamus, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

G2539 Issued in TX

Practice address

1804 NE Loop 410
#101
San Antonio, TX 78217-5211

Phone

(210) 828-8400

Fax

(210) 804-4454

NPI assigned

Sep 1, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Texas Digestive Disease Consultants, PLLC

  • Gastroenterology Physician
  • Irving, TX
  • NPI 1053397331
  Medicare reassignment NPD
• Texas Digestive Disease Consultants, PLLC

  • Gastroenterology Physician
  • Southlake, TX
  • NPI 1649256546
  NPD
• Texas Digestive Disease Consultants PLLC

  • Gastroenterology Physician
  • Covington, LA
  • NPI 1295428415
  NPD

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284422400000",
    "number": "1497749790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 NE LOOP 410",
            "address_2": "#101",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782175211",
            "telephone_number": "210-828-8400",
            "fax_number": "210-804-4454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 NE LOOP 410",
            "address_2": "#101",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782175211",
            "telephone_number": "210-828-8400",
            "fax_number": "210-804-4454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLHAMUS",
        "first_name": "CLINTON",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2010-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TX",
            "license": "E8822",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TX",
            "license": "G2539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114369504",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katelyn Polansky
• Rebecca Jane Polaschek
• Robert John Polasek
• Alexis Rose Polczynski, DMD
• Candy Angelita Polendo, RN
• Ekaterina Michaela Polinski, LPMHCA
• Brian D Poliquin, PA-C
• Polished Pediatric Dentistry
• Kennie T Polit, LPC
• Viktor Polivka

• Gastroenterology Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Gastroenterology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2010; 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.