NPIMap

Individual provider Active NPI

Tiffany E Polo

  • Nurse Practitioner
  • King William, VA
National Provider Identifier
1548640873
Registry record updated Jul 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0024172717 Issued in VA
Practice address
1041 Sharon Rd
Suite 205
King William, VA 23086-3347
Phone
(804) 746-1677
Fax
(804) 769-3170
NPI assigned
Jun 2, 2015
Last updated
Jul 16, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0024172717 VA Primary

Addresses

Primary practice location

1041 Sharon Rd
Suite 205
King William, VA 23086-3347

Mailing address

1041 Sharon Rd
Suite 205
King William, VA 23086-3347
Phone (804) 746-1677

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150819006919 VA Practitioner - Nurse Practitioner 5496060592 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Richmond Heart and Vascular AssociatesGroup PAC ID 4385039718, 23 clinicians

Practice addresses (Care Compare)

8243 Meadowbridge Rd
Mechanicsville, VA 23116-2329
Phone (804) 800-6600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Richmond Heart and Vascular Associates CurrentSince Jan 2, 2024 Accepting new patients
Bon Secours Memorial Regional Medical Center Inc Past Accepting new patients

Locations

8243 Meadowbridge Rd
Mechanicsvlle, VA 23116
Phone (804) 730-1481

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25854/brand/4/csg/1/fhir/r4
  • Direct secure messaging: tiffany.polo.1@25854.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1433203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437004800000",
    "number": "1548640873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 SHARON RD",
            "address_2": "SUITE 205",
            "city": "KING WILLIAM",
            "state": "VA",
            "postal_code": "230863347",
            "telephone_number": "804-746-1677",
            "fax_number": "804-769-3170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 SHARON RD",
            "address_2": "SUITE 205",
            "city": "KING WILLIAM",
            "state": "VA",
            "postal_code": "230863347",
            "telephone_number": "804-746-1677",
            "fax_number": "804-769-3170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLO",
        "first_name": "TIFFANY",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-02",
        "last_updated": "2015-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024172717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in King William, VA

Sources for this page

Verify at the official NPI Registry.