Shayne Elizabeth Polley, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

125.078356 Issued in IL

Practice address

4440 W 95TH St
Oak Lawn, IL 60453-2600

Phone

(708) 684-8000

Fax

(708) 684-3776

NPI assigned

Apr 6, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• The Fort Defiance Indian Hospital Board, Incorporation

  • General Acute Care Hospital
  • Fort Defiance, AZ
  • NPI 1477876639

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1617667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784246400000",
    "number": "1902485063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3142",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865043142",
            "telephone_number": "928-729-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532600",
            "telephone_number": "708-684-8000",
            "fax_number": "708-684-3776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Tsehootsooi Medical Center",
            "address_2": "Corners of Routes N12 & N7",
            "address_purpose": "LOCATION",
            "city": "Fort Defiance",
            "state": "AZ",
            "postal_code": "86504",
            "country_code": "US",
            "telephone_number": "928-729-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLLEY",
        "first_name": "SHAYNE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-06",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "DR.0077765",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125.078356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nagendra Polavarapu, M.D.
• Andrew Polisiakewicz
• Bridget B Polito
• Lindsey Polke
• Leland Pollard
• Kristina Nichole Pontarelli, M.D.
• Caitlin Nicole Pook, MD
• Alexandra Popescu, M.D.
• Jeffrey H Port, M.D.
• Arkaria Porter, BEHAVIOR THERAPIST

• Emergency Medicine Physician in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.