Active NPI
Indyana Polley
- Physician Assistant
- Modesto, CA
National Provider Identifier
1679036644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA57094
- Practice address
- 1431 McHenry Ave Ste 100
Modesto, CA 95350-4534 - Phone
- (209) 579-2300
- NPI assigned
- Apr 8, 2019
- Last updated
- Apr 22, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA57094 | CA | Primary |
Addresses
Primary practice location
1431 McHenry Ave Ste 100
Modesto, CA 95350-4534
Mailing address
1691 The Alameda
San Jose, CA 95126-2203
Phone (408) 287-7526
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57094 | CA | MD | Pediatric Dentist |
| PA57094 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dignity Health | Past | Accepting new patients | |
| Lifetreat Nursing Corporation | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Mercy Medical Center Redding
- General Acute Care Hospital
- Redding, CA
- NPI 1477671535
-
dba Lifetreat urgentcare and wellness center
- Family Nurse Practitioner
- Stockton, CA
- NPI 1912699802
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650585600000",
"number": "1679036644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1691 THE ALAMEDA",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951262203",
"telephone_number": "408-287-7526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1431 MCHENRY AVE STE 100",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504534",
"telephone_number": "209-579-2300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLEY",
"first_name": "INDYANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-08",
"last_updated": "2022-04-22",
"certification_date": "2022-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA57094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.