Individual provider Active NPI

Alexandra Polus, D.M.D.

  • Prosthodontics
  • Crown Point, IN
National Provider Identifier
1750799565
Registry record updated Jul 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
12012199A Issued in IN
Practice address
1549 S Court St Ste B
Crown Point, IN 46307-4809
Phone
(219) 662-0131
NPI assigned
Jul 24, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 24, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 12012199A IN Primary

Addresses

Primary practice location

1549 S Court St Ste B
Crown Point, IN 46307-4809

Mailing address

1549 S Court St Ste B
Crown Point, IN 46307-4809
Phone (219) 662-0131

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150515000436 IN Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6608196670
I20150518001938 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6608196670

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12012199AINMDProsthodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Polus Dental 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.

NPI Registry JSON

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

{
    "created_epoch": "1406160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406160000000",
    "number": "1750799565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1549 S COURT ST STE B",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463074809",
            "telephone_number": "219-662-0131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1549 S COURT ST STE B",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463074809",
            "telephone_number": "219-662-0131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLUS",
        "first_name": "ALEXANDRA",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-24",
        "last_updated": "2014-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "IN",
            "license": "12012199A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.