NPIMap

Organization Active NPI

Sports Medicine North Orthopaedic Surgery, Inc.

  • Specialist
  • Peabody, MA
National Provider Identifier
1760423719
Registry record updated Oct 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SPORTS MEDICINE NORTH ORTHOPAEDIC SURGERY, INC.
Practice address
1 Orthopedic Dr
2ND Floor
Peabody, MA 01960-1668
Phone
(978) 818-6350
Fax
(978) 818-6355
NPI assigned
Jun 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2025

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

Authorized official

Name
Dr. Jeffrey A. Polansky, M.D.
Title
President
Phone
(978) 818-6350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1 Orthopedic Dr
2ND Floor
Peabody, MA 01960-1668

Mailing address

1 Orthopedic Dr
2ND Floor
Peabody, MA 01960-1668
Phone (978) 818-6350

Other identifiers 1

IdentifierTypeStateIssuer
9773363MedicaidMA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040510000769 MA Part B Supplier - Clinic/Group Practice 0547259095 Receives reassigned benefits from 111 practitioners
1 other NPI on this enrollment
Practice locations: Manchester, MA; Wenham, MA; Peabody, MA; Newburyport, MA; Middleton, MA; Gloucester, MA; Beverly, MA
O20100930024394 MA DME Supplier - Multi-Specialty - PhysicianDME Supplier - Independently-Practicing Physical Therapist 0547259095 Practice locations: Peabody, MA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

30 Tozer Rd
Ste 211
Beverly, MA 01915

30 Tozer Rd
Ste 3001
Beverly, MA 01915

1 Wallace Bashaw Way
Ste 3005
Newburyport, MA 01950

20 Graf Rd
#J
Newburyport, MA 01950

20 Henry Graf Jr Rd
Newburyport, MA 01950
Phone (774) 208-8178

112 Parker St
Lowr
Newburyport, MA 01950
Phone (978) 572-4333

2 1st Ave
Peabody, MA 01960
Phone (978) 535-1213

Practitioners & affiliated clinicians

Practitioners 123

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 123

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760659200000",
    "number": "1760423719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ORTHOPEDIC DR",
            "address_2": "2ND FLOOR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019601668",
            "telephone_number": "978-818-6350",
            "fax_number": "978-818-6355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ORTHOPEDIC DR",
            "address_2": "2ND FLOOR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019601668",
            "telephone_number": "978-818-6350",
            "fax_number": "978-818-6355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS MEDICINE NORTH ORTHOPAEDIC SURGERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A",
        "authorized_official_last_name": "POLANSKY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-818-6350",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9773363",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Peabody, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.