NPIMap

Organization Active NPI

Roberto Polanco MD PA

  • Specialist
  • Miami, FL
National Provider Identifier
1669653291
Registry record updated Aug 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
ME62015 Issued in FL
Legal business name
ROBERTO POLANCO MD PA
Practice address
8501 SW 124TH Ave
102A
Miami, FL 33183-4627
Phone
(305) 228-4422
Fax
(305) 596-4422
NPI assigned
Nov 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2011

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

Authorized official

Name
Mr. Onel Montalvo, CPC,MA
Title
Manager
Phone
(786) 345-6991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X ME62015 FL Primary

Addresses

Primary practice location

8501 SW 124TH Ave
102A
Miami, FL 33183-4627

Mailing address

PO Box 655009
Miami, FL 33265-5009
Phone (305) 228-4422

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080130000552 FL Part B Supplier - Clinic/Group Practice 3274615109 Receives reassigned benefits from 13 practitioners
Practice locations: Miami, FL

National Provider Directory

National Provider Directory

Locations

8501 SW 124th Ave
Ste 102A
Miami, FL 33183
Phone (305) 228-4422

7600 SW 8th St
Miami, FL 33144
Phone (305) 261-2525

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313366400000",
    "number": "1669653291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 655009",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "332655009",
            "telephone_number": "305-228-4422",
            "fax_number": "305-596-4422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8501 SW 124TH AVE",
            "address_2": "102A",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331834627",
            "telephone_number": "305-228-4422",
            "fax_number": "305-596-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERTO POLANCO MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-26",
        "last_updated": "2011-08-15",
        "status": "A",
        "authorized_official_last_name": "MONTALVO",
        "authorized_official_first_name": "ONEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "786-345-6991",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPC,MA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME62015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.