Individual provider Active NPI

Alan Ricky Pollack, MD

  • Internal Medicine Physician
  • Rockville, MD
National Provider Identifier
1790781979
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0033443 Issued in MD
Practice address
1201 Seven Locks Rd
Ste 111
Rockville, MD 20854-2957
Phone
(301) 762-5020
Fax
(301) 294-7569
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X D0033443 MD
Internal Medicine Physician 207R00000X D0033443 MD Primary

Addresses

Primary practice location

1201 Seven Locks Rd
Ste 111
Rockville, MD 20854-2957

Mailing address

PO Box 79632
Baltimore, MD 21279-0632
Phone (301) 762-5020

Other identifiers 1

IdentifierTypeStateIssuer
433961600MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20081211000640 DC Practitioner - Internal MedicinePractitioner - Pulmonary Disease 4385668441 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0033443MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Care Center LLC Internal Medicine CurrentSince Oct 4, 2018 Accepting new patients
Privia Medical Group, LLC Internal Medicine CurrentSince Feb 29, 2016 Accepting new patients
Privia Medical Group, LLC CurrentSince Feb 29, 2016 Accepting new patients
Jackson Park Hospital Foundation Current Accepting new patients
Privia Care Center LLC Internal Medicine CurrentSince Oct 4, 2018 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

4910 Massachusetts Ave NW
Ste 114
Washington, DC 20016
Phone (202) 244-0812

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

1201 Seven Locks Rd
Ste 111
Rockville, MD 20854
Phone (301) 762-5020

Interoperability endpoints

  • Direct secure messaging: alanpollack@jph.medalliesdirect.net

Organizations & group practices 6

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": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476057600000",
    "number": "1790781979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 79632",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212790632",
            "telephone_number": "301-762-5020",
            "fax_number": "301-309-3783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SEVEN LOCKS RD",
            "address_2": "STE 111",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208542957",
            "telephone_number": "301-762-5020",
            "fax_number": "301-294-7569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLACK",
        "first_name": "ALAN",
        "middle_name": "RICKY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2016-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MD",
            "license": "D0033443",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0033443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "433961600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

Verify at the official NPI Registry.