Individual provider Active NPI

Jillian A. Polonchak, AGACNP-BC

  • Critical Care Medicine (Anesthesiology) Physician
  • Los Angeles, CA
National Provider Identifier
1942850888
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Anesthesiology) PhysicianTaxonomy code 207LC0200X
License
R256994 Issued in MD
Practice address
1520 San Pablo St Ste 3000
Los Angeles, CA 90033-5315
Phone
(323) 442-5710
NPI assigned
Sep 12, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X NP95012773 CA
Critical Care Medicine (Anesthesiology) Physician 207LC0200X R256994 MD Primary

Addresses

Primary practice location

1520 San Pablo St Ste 3000
Los Angeles, CA 90033-5315

Mailing address

6201 Greenleigh Ave FL 2
Middle River, MD 21220-2004
Phone (410) 933-2704

Other practice location 1

1800 Orleans St
Baltimore, MD 21287-0010
Phone (410) 955-8893

Other names 1

  • Jill A. Schimke Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jillian.polonchak@direct.usc.edu Direct USC CARE MEDICAL GROUP, INC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, MD2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191101001793 CA Practitioner - Nurse Practitioner 8426380981 Reassigns benefits to 1 organization
I20230111001495 MD Practitioner - Nurse Practitioner 8426380981 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
May accept Medicare assignment
Group practices
Johns Hopkins UniversityGroup PAC ID 8921903147, 2,886 clinicians

Practice addresses (Care Compare)

600 N Wolf St
Baltimore, MD 21287-0005
Phone (410) 955-5000

600 N Wolfe St
Blalock 266
Baltimore, MD 21287-0005
Phone (410) 502-4340

6201 Greenleigh Ave
Middle River, MD 21220-2004

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R256994MDMDCritical Care Medicine (Anesthesiology) Physician
NP95012773CAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins University CurrentSince Jan 1, 2023 Accepting new patients
Johns Hopkins University Critical Care Medicine CurrentSince Jan 1, 2023 Accepting new patients
Johns Hopkins University Current Accepting new patients
Usc Care Medical Group, Inc CurrentSince Oct 1, 2019 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Oct 1, 2019 Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1520 San Pablo St
Ste 3000
Los Angeles, CA 90033
Phone (323) 442-5728

1540 Alcazar St
Ste 215
Los Angeles, CA 90089
Phone (323) 442-7686

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

600 N Wolfe St
Baltimore, MD 21287

1800 Orleans St
Baltimore, MD 21287
Phone (410) 502-2037

6201 Greenleigh Ave
Fl 2
Middle River, MD 21220
Phone (410) 933-2704

6201 Greenleigh Ave
Middle River, MD 21220
Phone (410) 933-2704

Interoperability endpoints

  • Direct secure messaging: jpolonchak1036825@direct.hopkinsmedicine.org

Organizations & group practices 5

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 1

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": "1568246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1942850888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 GREENLEIGH AVE FL 2",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212202004",
            "telephone_number": "410-933-2704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 SAN PABLO ST STE 3000",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335315",
            "telephone_number": "323-442-5710"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Orleans St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212870010",
            "country_code": "US",
            "telephone_number": "410-955-8893",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLONCHAK",
        "first_name": "JILLIAN",
        "middle_name": "A.",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-12",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "NP95012773",
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "MD",
            "license": "R256994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jillian.polonchak@direct.usc.edu",
            "affiliation": "Y",
            "affiliationName": "USC CARE MEDICAL GROUP, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1520 San Pablo St Ste 3000",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900335315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "SCHIMKE",
            "middle_name": "A.",
            "credential": "AGACNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.