Rebecca Marie Polkabla, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4661 Issued in AZ

Practice address

15021 W Bell Rd Ste 125
Surprise, AZ 85374-3916

Phone

(623) 476-7880

Fax

(623) 476-7890

NPI assigned

Jul 23, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Greater Phoenix Collaborative Care PCGroup PAC ID 0941503304, 111 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rebecca.polkabla@mspi-az.direct.office.nextgen.com
• Direct secure messaging: rpolkabla114272@westdirect.optum.com

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.

• Greater Phoenix Collaborative Care PC

  • Clinic/Center
  • Phoenix, AZ
  • NPI 1750686614
  Medicare reassignment Care Compare group NPD
• 4C Medical Group PLC

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1558654384
  Medicare reassignment NPD (past)

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

{
    "created_epoch": "1279843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1649583238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15021 W BELL RD STE 125",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853743916",
            "telephone_number": "623-476-7880",
            "fax_number": "623-476-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLKABLA",
        "first_name": "REBECCA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-23",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4661",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z302379",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "642812",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Pluim, RN
• Ashley Plum
• Cindy S Poe, SCHOOL PSYCHOLOGIST
• Trisha Poer
• Gregory Poland
• Ginger Lee Pollock, RN
• Patricia S. Polson, MSN/FNP, CRNFA
• Pool of Bethesda Psychiatric Health LLC
• Raymond Popp, MPT
• Chy Anna Marie Porter, LPC

• Physician Assistant in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; 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.

Verify at the official NPI Registry.