Individual provider Active NPI

Denise Marie Polaski, MD

  • Psychiatry Physician
  • Portland, OR
National Provider Identifier
1760047203
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD219629 Issued in OR
Practice address
1225 NE 2ND Ave
Portland, OR 97232-2003
Phone
(503) 944-8000
NPI assigned
May 9, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X MD219629 OR Primary

Addresses

Primary practice location

1225 NE 2ND Ave
Portland, OR 97232-2003

Mailing address

3600 Forbes Ave Ste 140
Pittsburgh, PA 15213-3410

Other practice location 1

3811 OHara St Ste 431
Pittsburgh, PA 15213-2561
Phone (412) 246-5320

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20240924002005 OR Practitioner - Psychiatry 5799011730 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD219629ORMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Emanuel Hospital & Health Center Psychiatry CurrentSince Sep 12, 2024 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Sep 12, 2024 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients

Locations

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

1225 NE 2nd Ave
Portland, OR 97232
Phone (503) 413-5051

Organizations & group practices 3

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": "1557360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1760047203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 FORBES AVE STE 140",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152133410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 NE 2ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322003",
            "telephone_number": "503-944-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3811 OHara St Ste 431",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152132561",
            "country_code": "US",
            "telephone_number": "412-246-5320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLASKI",
        "first_name": "DENISE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-09",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD219629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.