Individual provider Active NPI

Patricia S. Polson, MSN/FNP, CRNFA

  • Family Nurse Practitioner
  • Surprise, AZ
National Provider Identifier
1639129299
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F0604150 Issued in AZ
Practice address
12361 W Bola Dr Ste 107
Surprise, AZ 85378-9021
Phone
(623) 266-1333
Fax
(602) 773-5674
NPI assigned
May 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F0604150 AZ Primary

Addresses

Primary practice location

12361 W Bola Dr Ste 107
Surprise, AZ 85378-9021

Mailing address

12361 W Bola Dr Ste 107
Surprise, AZ 85378-9021
Phone (623) 266-1333

Other identifiers 5

IdentifierTypeStateIssuer
1912990094OtherAZAHCCCS
730511OtherAZUNITED HEALTHCARE
5124334OtherAZAETNA
P0185990OtherAZBCBS OUT OF AREA
2Z3248OtherAZHEALTHNET

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040817001415 AZ Practitioner - Nurse Practitioner 7719950708

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F0604150AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sun Valley Health & Wellness LLC CurrentSince Feb 20, 2025 Accepting new patients

Locations

12361 W Bola Dr
Ste 107
Surprise, AZ 85378
Phone (623) 266-1333

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HFBADD/Endpoint/HFBADD

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1639129299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12361 W BOLA DR STE 107",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853789021",
            "telephone_number": "623-266-1333",
            "fax_number": "602-773-5674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12361 W BOLA DR STE 107",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853789021",
            "telephone_number": "623-266-1333",
            "fax_number": "602-773-5674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLSON",
        "first_name": "PATRICIA",
        "middle_name": "S.",
        "credential": "MSN/FNP, CRNFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "F0604150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "1912990094",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "730511",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5124334",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OUT OF AREA",
            "identifier": "P0185990",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "2Z3248",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Surprise, AZ

Sources for this page

Verify at the official NPI Registry.