Active NPI
Michael Leon Polansky, PA-C
- Physician Assistant
- Omaha, NE
National Provider Identifier
1700800679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 739
- Practice address
- 16101 Evans St
Omaha, NE 68116 - Phone
- (402) 717-9797
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 093064 | IA | |
| Medical Physician Assistant | 363AM0700X | PA02151 | TX | |
| Physician Assistant | 363A00000X | 739 | NE | Primary |
Addresses
Primary practice location
16101 Evans St
Omaha, NE 68116
Mailing address
13807 Tregaron Dr
Bellevue, NE 68123-4751
Other practice location 1
3135 W Broadway
Council Bluffs, IA 51501-3359
Phone (712) 242-2040
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 |
|---|---|---|---|
| 739 | NE | MD | Occupational Therapy Assistant |
| PA02151 | TX | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alegent Creighton Clinic | Physician Assistant | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Council Bluffs, IA
- NPI 1598811069
Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534204800000",
"number": "1700800679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13807 TREGARON DR",
"city": "BELLEVUE",
"state": "NE",
"postal_code": "681234751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16101 EVANS ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "68116",
"telephone_number": "402-717-9797"
}
],
"practiceLocations": [
{
"address_1": "3135 W Broadway",
"address_purpose": "LOCATION",
"city": "Council Bluffs",
"state": "IA",
"postal_code": "515013359",
"country_code": "US",
"telephone_number": "712-242-2040",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "POLANSKY",
"first_name": "MICHAEL",
"middle_name": "LEON",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2018-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IA",
"license": "093064",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA02151",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.