Active NPI
Travis Alexander Polston, MD
- Family Medicine Physician
- Seattle, WA
National Provider Identifier
1578052882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD61161867
- Practice address
- 1401 Madison St Ste 100
Seattle, WA 98104-1316 - Phone
- (206) 386-6111
- Fax
- (206) 386-6113
- NPI assigned
- May 2, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD.61161867 | WA | |
| Family Medicine Physician | 207Q00000X | MD61161867 | WA | Primary |
Addresses
Primary practice location
1401 Madison St Ste 100
Seattle, WA 98104-1316
Mailing address
PO Box 25608
Salt Lake City, UT 84125-0608
Phone (206) 320-4476
Other names 1
- T. Alex Polston
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tpolston862992@wm.providencedirect.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK, TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
222 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411
Hospital & facility affiliations
- Southeast Alaska Regional Health Consortium
- Southeast Alaska Regional Health Consortium
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD.61161867 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| City of Valdez | Current | Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Past | Accepting new patients |
Locations
3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000
222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423
911 Meals Ave
Valdez, AK 99686
Phone (907) 835-2249
Interoperability endpoints
- tpolston862992@wm.providencedirect.org
Organizations & group practices 5
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.
-
- Critical Access Hospital Clinic/Center
- Valdez, AK
- NPI 1427424282
-
- Clinic/Center
- Juneau, AK
- NPI 1427941343
-
- Clinic/Center
- Gustavus, AK
- NPI 1649716226
-
- Critical Access Hospital
- Sitka, AK
- NPI 1720062524
Hospital & facility affiliations 36
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Clinic/Center
- Tenakee Springs, AK
- NPI 1477721280
Hospital
-
- Nursing Facility/Intermediate Care Facility
- Juneau, AK
- NPI 1932312485
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636502400000",
"number": "1578052882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 25608",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841250608",
"telephone_number": "206-320-4476",
"fax_number": "206-568-7043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 MADISON ST STE 100",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981041316",
"telephone_number": "206-386-6111",
"fax_number": "206-386-6113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLSTON",
"first_name": "TRAVIS",
"middle_name": "ALEXANDER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-02",
"last_updated": "2021-11-10",
"certification_date": "2021-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD.61161867",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD61161867",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "tpolston862992@wm.providencedirect.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1401 Madison St Ste 100",
"city": "Seattle",
"state": "WA",
"country_code": "US",
"postal_code": "981041316",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "T.",
"last_name": "POLSTON",
"middle_name": "ALEX",
"credential": "MD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.