Kevin M Polky, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

461 N Mulford Rd
Condo #1
Rockford, IL 61107-5190

Phone

(815) 395-1141

Fax

(815) 395-1117

NPI assigned

Oct 10, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Four Corners Wellness Center, LTDGroup PAC ID 3971017625, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Fourcorners Wellness Center, LTD

  • Clinical Social Worker
  • Loves Park, IL
  • NPI 1932968633
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191974400000",
    "number": "1902094469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 N MULFORD RD",
            "address_2": "CONDO #1",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075190",
            "telephone_number": "815-395-1141",
            "fax_number": "815-395-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 N MULFORD RD",
            "address_2": "CONDO #1",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075190",
            "telephone_number": "815-395-1141",
            "fax_number": "815-395-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLKY",
        "first_name": "KEVIN",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-10",
        "last_updated": "2007-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dilem Polat, MD
• Michael James Polizzotto, M.D.
• Amber Polk
• Daisy Polk
• Kalab Polky
• Jacob Pollock
• Lynne Marie Pollock, LCSW
• Jill Marie Polsean, PTA
• Kelly Polz
• Aramide A Ponnle, DPT

• Clinical Social Worker in Rockford, IL
• Providers in Rockford, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.