NPIMap

Individual provider Active NPI

Aaron C Polk Jr., MD

  • Family Medicine Physician
  • Nacogdoches, TX
National Provider Identifier
1578595997
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E7231 Issued in TX
Practice address
212 Russell Blvd
Nacogdoches, TX 75965
Phone
(936) 569-9238
Fax
(936) 569-8530
NPI assigned
Jul 7, 2006
Last updated
Jun 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E7231 TX Primary

Addresses

Primary practice location

212 Russell Blvd
Nacogdoches, TX 75965

Mailing address

212 Russell Blvd
Nacogdoches, TX 75965
Phone (936) 569-9238

Other identifiers 1

IdentifierTypeStateIssuer
110452302MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20100921001542 TX Practitioner - Family Practice 4385760800 Practice locations: Nacogdoches, TX

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in Shreveport, 1974
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

212 Russell Blvd
Nacogdoches, TX 75965-1237
Phone (936) 569-9238

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy50
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions24
Removal of nail tissue1-10
Removal or shaving of skin growth77
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Hospital & facility affiliations 8

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1578595997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 RUSSELL BLVD",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "75965",
            "telephone_number": "936-569-9238",
            "fax_number": "936-569-8530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 RUSSELL BLVD",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "75965",
            "telephone_number": "936-569-9238",
            "fax_number": "936-569-8530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLK",
        "first_name": "AARON",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "E7231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110452302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nacogdoches, TX

Sources for this page

Verify at the official NPI Registry.