Individual provider Active NPI

Kalpana R Polu, M.D.

  • Psychiatry Physician
  • Providence, RI
National Provider Identifier
1740219534
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD16062 Issued in RI
Practice address
345 Blackstone Blvd
Providence, RI 02906-4800
Phone
(401) 456-6200
NPI assigned
Jul 2, 2006
Last updated
Jul 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD16062 RI Primary
Child & Adolescent Psychiatry Physician 2084P0804X MD16062 RI
Child & Adolescent Psychiatry Physician 2084P0804X 212599 MA

Addresses

Primary practice location

345 Blackstone Blvd
Providence, RI 02906-4800

Mailing address

455 Toll Gate Rd
Warwick, RI 02886-2759
Phone (401) 273-0641

Other practice location 1

200 May St
South Attleboro, MA 02703-5520
Phone (508) 838-2212

Other names 1

  • Kalpana Yalala Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kpolu@kent.cernerdirect.carene.org Health Information Exchange (HIE)
Direct Messaging Address kpolu@direct.carene.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, RI2 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

Enrollment IDStateProvider typePAC IDDetails
I20040406000086 MA Practitioner - Psychiatry 9739172875 Reassigns benefits to 1 organization
I20180301000455 RI Practitioner - PsychiatryPractitioner - Addiction Medicine 9739172875 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Uhs of Fuller IncGroup PAC ID 3274510003, 23 clinicians

Practice addresses (Care Compare)

200 May St
South Attleboro, MA 02703-5520
Phone 50876185002263

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
212599MAMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Chartercare RWMC, LLC CurrentSince Feb 10, 2018 Accepting new patients
Uhs of Fuller Inc Psychiatry CurrentSince Jan 13, 2004 Accepting new patients
Prospect Chartercare RWMC, LLC CurrentSince Feb 10, 2018 Accepting new patients
Prospect Chartercare Sjhsri, LLC Psychiatry CurrentSince Nov 15, 2017 Accepting new patients
Prospect Chartercare Sjhsri, LLC CurrentSince Nov 15, 2017 Accepting new patients

Locations

200 May St
South Attleboro, MA 02703
Phone (508) 761-8500

2 Wake Robin Rd
Lincoln, RI 02865
Phone (401) 333-1747

200 High Service Ave
North Providence, RI 02904
Phone (401) 456-3000

825 Chalkstone Ave
Providence, RI 02908
Phone (401) 456-2000

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1740219534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 TOLL GATE RD",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862759",
            "telephone_number": "401-273-0641",
            "fax_number": "401-273-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 BLACKSTONE BLVD",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064800",
            "telephone_number": "401-456-6200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 May St",
            "address_purpose": "LOCATION",
            "city": "South Attleboro",
            "state": "MA",
            "postal_code": "027035520",
            "country_code": "US",
            "telephone_number": "508-838-2212",
            "fax_number": "508-838-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLU",
        "first_name": "KALPANA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-02",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "RI",
            "license": "MD16062",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "RI",
            "license": "MD16062",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MA",
            "license": "212599",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpolu@kent.cernerdirect.carene.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "345 Blackstone Blvd",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029064800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpolu@direct.carene.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "345 Blackstone Blvd",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029064800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KALPANA",
            "last_name": "YALALA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.