Jose Roman Polanco, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

273647 Issued in MA

Practice address

31 Roche Bros Way
North Easton, MA 02356-1032

Phone

(508) 894-8730

Fax

(508) 894-8732

NPI assigned

Dec 5, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Edgewood Medical LLC

  • Internal Medicine Physician
  • Cranston, RI
  • NPI 1952501421
  NPD (past) Authorized official
• Blackstone Valley Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pawtucket, RI
  • NPI 1063574135
  NPD (past)
• Blackstone Valley Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Central Falls, RI
  • NPI 1275847766
  NPD (past)
• Memorial Hospital

  • General Acute Care Hospital
  • Pawtucket, RI
  • NPI 1548696941

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593043200000",
    "number": "1609850411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 BARTLETT AVE",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029051334",
            "telephone_number": "401-529-3571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 ROCHE BROS WAY",
            "city": "NORTH EASTON",
            "state": "MA",
            "postal_code": "023561032",
            "telephone_number": "508-894-8730",
            "fax_number": "508-894-8732"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "545 Bedford St",
            "address_purpose": "LOCATION",
            "city": "Bridgewater",
            "state": "MA",
            "postal_code": "023243117",
            "country_code": "US",
            "telephone_number": "508-697-3677",
            "fax_number": "508-697-9396",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLANCO",
        "first_name": "JOSE",
        "middle_name": "ROMAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD10514",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "273647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "S400453494",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110131381A",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7009048",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Marie Petillo, D.O.
• Jill N Petruchik, CCC-SLP
• Cindy Pham
• Lothida Phothisane
• Susan K Plante, APRN
• Robert Charles Portman, PSY.D.
• Robert S Powell, D.O.
• Donald P Prohovich, D.D.S.
• Mia Pruett, PH.D.
• Psychological Associates of Southeastern Massachusetts, LLC

• Internal Medicine Physician in North Easton, MA
• Providers in North Easton, MA by specialty
• Internal Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; 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.