Donovan C Polack, MD

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

R5H69 Issued in MO

Practice address

1265 Graham Rd Ste 1
Florissant, MO 63031-8018

Phone

(314) 741-1600

Fax

(314) 741-1677

NPI assigned

May 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO, IL2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14360/brand/23/csg/1/fhir/r4
• Direct secure messaging: dpolack31091@direct.acumenmd.com
• Direct secure messaging: dpolack134249@direct.carenet.org

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.

• St Louis Kidney Care LLC

  • Nephrology Physician
  • Florissant, MO
  • NPI 1780058727

  IL, MO, Nephrology

  Medicare reassignment Care Compare group NPD
• Doctors Group , PC

  • Internal Medicine Physician
  • Bridgeton, MO
  • NPI 1730259888
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Metro Dialysis Center - North, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Florissant, MO
  • NPI 1932201118

  Dialysis facility

  Care Compare affiliation Name & address match
• Christian Hospital Northeast- Northwest

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1639186760

  Hospital

  Care Compare affiliation
• Christian Hospital Northeast-Northwest

  • Ambulance
  • Saint Louis, MO
  • NPI 1073769329

  Hospital

  Care Compare affiliation
• Mercy Hospital Jefferson

  • General Acute Care Hospital
  • Festus, MO
  • NPI 1508859661

  Hospital

  Care Compare affiliation
• SSM Health Care St. Louis

  • General Acute Care Hospital
  • Bridgeton, MO
  • NPI 1598835308

  Hospital

  Care Compare affiliation
• American Healthcare Systems Illinois LLC

  • General Acute Care Hospital
  • Granite City, IL
  • NPI 1326765884

  Hospital

  Care Compare affiliation
• American Healthcare Systems Illinois LLC

  • Urgent Care Clinic/Center
  • Glen Carbon, IL
  • NPI 1700586344

  Hospital

  Care Compare affiliation
• American Healthcare Systems Illinois LLC

  • Clinic/Center
  • Edwardsville, IL
  • NPI 1760182307

  Hospital

  Care Compare affiliation
• American Healthcare Systems Illinois LLC

  • Clinic/Center
  • Waterloo, IL
  • NPI 1770283301

  Hospital

  Care Compare affiliation
• American Healthcare Systems Illinois LLC

  • Urgent Care Clinic/Center
  • Columbia, IL
  • NPI 1982304523

  Hospital

  Care Compare affiliation

Specialty

Internal MedicineAlso: Nephrology

Education

JS Weill Medical College, Cornell University, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St Louis Kidney Care LLC 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Metro Dialysis Center - North Dialysis facility, Florissant, MO, CCN 262509
• Bma St. Louis Dialysis facility, Saint Ann, MO, CCN 262507
• Christian Hospital Northeast Hospital, Saint Louis, MO, CCN 260180
• SSM Health Depaul Hospital St Louis Hospital, Bridgeton, MO, CCN 260104
• Gateway Regional Medical Center Hospital, Granite City, IL, CCN 140125
• Mercy Hospital Jefferson Hospital, Crystal City, MO, CCN 260023

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1659324465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1265 GRAHAM RD STE 1",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630318018",
            "telephone_number": "314-741-1600",
            "fax_number": "314-741-1677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 GRAHAM RD STE 1",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630318018",
            "telephone_number": "314-741-1600",
            "fax_number": "314-741-1677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2044 Madison Ave Ste 15",
            "address_purpose": "LOCATION",
            "city": "Granite City",
            "state": "IL",
            "postal_code": "620404641",
            "country_code": "US",
            "telephone_number": "314-741-1600",
            "fax_number": "314-741-1677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLACK",
        "first_name": "DONOVAN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036-072078",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "R5H69",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IL",
            "license": "036-072078",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "R5H69",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036072078",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202546321",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dpolack31091@direct.acumenmd.com",
            "affiliation": "N",
            "address_1": "1265 Graham Rd Ste 1",
            "city": "Florissant",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630318018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Platinum Healthcare Living Services LLC
• Platinum Home Healthcare, LLC
• Pleasant Journey Mobile Lab
• Carrie Lee Plisco, WHNP, AGPCNP
• Irwin Plisco, M.D.
• Roseline Omolola Popoola, BS
• John A Powers, PNP
• Precious Palms in-Home Services LLC
• Predictive Needs Healthcare Services LLC
• Preferred Family Healthcare, Inc.

• All providers in Florissant, MO
• Nephrology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; 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.