Nishta Polam, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

5151016993 Issued in MI

Practice address

965 Wilson Rd RM A233
East Lansing, MI 48824-6410

Phone

(517) 353-4362

Fax

(517) 432-0927

NPI assigned

Apr 15, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Interoperability endpoints

• Direct secure messaging: nishta.polam.1@25394.direct.athenahealth.com

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1548014889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4540 HUNT CLUB DR APT 1A",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481979097",
            "telephone_number": "804-332-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 WILSON RD RM A233",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488246410",
            "telephone_number": "517-353-4362",
            "fax_number": "517-432-0927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLAM",
        "first_name": "NISHTA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5151016993",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Podmore, LMSW, CAADC
• Kimberly Anne Poe, MSN, APRN
• Monica Poff, LMSW
• Phoebe Caroline Pohl
• Christopher Adam Pohlod, D.O.
• Mark Vincent Poletti, DC
• Michele Ollie Poorman, PHD
• Julia Bowman Popenoe, M.D.
• Zayvryannah Porter, HS
• Louis Post, PHD

• Psychiatry Physician in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; 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.