NPIMap

Individual provider Active NPI

Ninan S Polackal, M.D.

  • Internal Medicine Physician
  • Worcester, MA
National Provider Identifier
1912980814
Registry record updated Nov 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
205191 Issued in MA
Practice address
1 West Boylston Street
3Rd Floor
Worcester, MA 01605-2138
Phone
(508) 334-8802
NPI assigned
Nov 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 205191 MA Primary

Addresses

Primary practice location

1 West Boylston Street
3Rd Floor
Worcester, MA 01605-2138

Mailing address

PO Box 415348
Boston, MA 02241-5348

Other identifiers 1

IdentifierTypeStateIssuer
2017211MedicaidMA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address npolackal23535@UmassMemorial.direct-ci.com
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080320000052 MA Practitioner - Internal Medicine 7315979531 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

1 W Boylston St
Worcester, MA 01605-1274
Phone (508) 854-2636

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Hospital & facility affiliations

  • Elara Caring Home health agency, Braintree, MA, CCN 227475
  • Vna Care Network Home health agency, Worcester, MA, CCN 227098
  • Preferred Transitions Home Health Care Inc Home health agency, Milford, MA, CCN 227666
  • Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163
  • Umass Memorial Health - Harrington Hospital Hospital, Southbridge, MA, CCN 220019
  • St Vincent Hospital Hospital, Worcester, MA, CCN 220176
  • Umass Memorial Healthalliance Hospitals Hospital, Leominster, MA, CCN 220001

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
205191MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Group, Inc. CurrentSince Sep 1, 2003 Accepting new patients
Umass Memorial Medical Group Inc Internal Medicine CurrentSince Sep 1, 2003 Accepting new patients
Millinocket Regional Hospital Past Accepting new patients

Locations

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

1 W Boylston St
Fl 3
Worcester, MA 01605
Phone (508) 334-8802

Interoperability endpoints

  • Direct secure messaging: npolackal23535@umassmemorial.direct-ci.com

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606262400000",
    "number": "1912980814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WEST BOYLSTON STREET",
            "address_2": "3RD FLOOR",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052138",
            "telephone_number": "508-334-8802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLACKAL",
        "first_name": "NINAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-23",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "205191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2017211",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "npolackal23535@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "1 West Boylston Street",
            "address_2": "3rd Floor",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016052138",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1 West Boylston Street",
            "address_2": "3rd Floor",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016052138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.