Tiffany E Polo
Individual provider Active NPI Nurse Practitioner · King William, VA
NPI 1548640873 · NPPES record last updated Jul 16, 2015
Key facts
- NPI
- 1548640873
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 0024172717 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Richmond Heart and Vascular Associates
Practice addresses (Care Compare)
8243 Meadowbridge Rd
Mechanicsville, VA 23116-2329
Phone (804) 800-6600
Hospital & facility affiliations
- Brookside Home Health, an Amedisys Company
- Bon Secours Memorial Regional Medical Center
- Bon Secours Richmond Community Hospital
- Bon Secours St Marys Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150819006919 | VA | Practitioner - Nurse Practitioner | 5496060592 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Richmond Heart and Vascular Associates | Current |
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
- tiffany.polo.1@25854.direct.athenahealth.com
- https://api.platform.athenahealth.com/25854/brand/4/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 0024172717 | VA | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C05698 | Other | VA | GROUP PTAN |
Other providers in King William, VA
- Timothy Wayne McDaniel
- Philip Mitchell
- Pamunkey Indian Tribe
- Wendy G Phillips
- Morgan Plowman
- Robert M Rose
- Kristen Russell
- Kristine Shafer
- Sleep Medix, Inc.
- Jill S Storment
All providers in King William, VA · Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2015. 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.