Individual provider Active NPI

Mark J Polisar, MD

  • Family Medicine Physician
  • Bronx, NY
National Provider Identifier
1700956992
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
215837 Issued in NY
Practice address
MMG - Williamsbridge
3448 Boston Road
Bronx, NY 10469
Phone
(718) 547-6111
NPI assigned
Nov 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 215837 NY Primary

Addresses

Primary practice location

MMG - Williamsbridge
3448 Boston Road
Bronx, NY 10469

Mailing address

26 Sycamore LN
Irvington, NY 10533-1918
Phone (718) 547-6111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20080108000457 NY Practitioner - Family Practice 4587744206 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Albert Einstein College of Medicine of Yeshiva University, 1988
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255

Hospital & facility affiliations

  • Montefiore Medical Center Hospital, Bronx, NY, CCN 330059

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
215837NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Nov 1, 2010 Accepting new patients

Locations

3011 Boston Rd
Bronx, NY 10469
Phone (718) 547-6111

111 E 210th St
Bronx, NY 10467

360 E 193rd St
Bronx, NY 10458
Phone (718) 405-4067

3448 Boston Rd
Bronx, NY 10469
Phone (718) 547-6111

1055 E Tremont Ave
Bronx, NY 10460
Phone (718) 842-8040

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: mpolisar@montefioredirect.com

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700956992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 SYCAMORE LN",
            "city": "IRVINGTON",
            "state": "NY",
            "postal_code": "105331918",
            "telephone_number": "718-547-6111",
            "fax_number": "718-547-4749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MMG - WILLIAMSBRIDGE",
            "address_2": "3448 BOSTON ROAD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10469",
            "telephone_number": "718-547-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLISAR",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "215837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.