Active NPI
James R Poliquin, M.D.
- Vascular Surgery Physician
- Pikeville, KY
National Provider Identifier
1740234335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 42475
- Practice address
- 911 Bypass Rd
Pikeville, KY 41501-1689 - Phone
- (606) 218-4530
- Fax
- (606) 218-4540
- NPI assigned
- May 19, 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 42475 | KY | Primary |
| Surgery Physician | 208600000X | 0101033088 | VA | |
| Vascular Surgery Physician | 2086S0129X | 0101033088 | VA | |
| Colon & Rectal Surgery Physician | 208C00000X | 0101033088 | VA |
Addresses
Primary practice location
911 Bypass Rd
Pikeville, KY 41501-1689
Mailing address
PO Box 2917
Pikeville, KY 41502-2917
Phone (606) 218-4530
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4357943 | Other | AETNA PPO/MC | |
| 1458520 | Other | CIGNA | |
| 213383 | Other | OPTIMUM CHOICE | |
| 020044164 | Other | RAILROAD MEDICARE | |
| 213383 | Other | ALLIANCE/MDIPA/MAMSI | |
| 7100175390 | Medicaid | KY | |
| 0582455 | Other | AETNA HMO | |
| 071140 | Other | ANTHEM | |
| 15802 | Other | VA | OPTIMA MEDICAID |
| 285008 | Other | SOUTHERN HEALTH |
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42475 | KY | MD | Vascular Surgery Physician |
| 0101033088 | VA | MD | Vascular Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Commonwealth General & Vascular Surgery, P.C. | Past | Accepting new patients | |
| HCA Health Services of Virginia, Inc. | 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 and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334188800000",
"number": "1740234335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2917",
"city": "PIKEVILLE",
"state": "KY",
"postal_code": "415022917",
"telephone_number": "606-218-4530",
"fax_number": "606-218-4540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "911 BYPASS RD",
"city": "PIKEVILLE",
"state": "KY",
"postal_code": "415011689",
"telephone_number": "606-218-4530",
"fax_number": "606-218-4540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLIQUIN",
"first_name": "JAMES",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-19",
"last_updated": "2012-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "KY",
"license": "42475",
"primary": true
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "VA",
"license": "0101033088",
"primary": false
},
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "VA",
"license": "0101033088",
"primary": false
},
{
"code": "208C00000X",
"taxonomy_group": "",
"desc": "Colon & Rectal Surgery",
"state": "VA",
"license": "0101033088",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO/MC",
"identifier": "4357943",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1458520",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMUM CHOICE",
"identifier": "213383",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "020044164",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALLIANCE/MDIPA/MAMSI",
"identifier": "213383",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100175390",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "0582455",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "071140",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMA MEDICAID",
"identifier": "15802",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOUTHERN HEALTH",
"identifier": "285008",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Pikeville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.