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DR. DONOVAN C POLACK MD NPI 1659324465


NPI Information

NPI: 1659324465
Provider Name: DR. DONOVAN C POLACK, MD
Classification: Internal Medicine - 207RN0300X
Entity Type: Individual

Specialization: Nephrology

PECOS Registration: Yes

Address:
11155 DUNN RD
SUITE 211N
SAINT LOUIS, MO
ZIP 63136
Phone: (314) 741-1600
Get Directions

DR. Donovan C Polack, MD is a nephrology internal medicine in Saint Louis, MO with 45 years of experience. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. DR. Donovan C Polack, MD NPI is 1659324465. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: JS WEILL MEDICAL COLLEGE, CORNELL UNIVERSITY
Graduation Year:1979

The provider's business location address is:

11155 DUNN RD
SUITE 211N
SAINT LOUIS, MO
ZIP 63136-150
Phone: (314) 741-1600
Fax: (314) 741-1677

The NPI 1659324465 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Dialysis services (4 or more physician visits per month), patient 20 years of age and older (HCPCS:90960)
  • Dialysis services (2-3 physician visits per month), patient 20 years of age and older (HCPCS:90961)

The enumeration date for this NPI number is 5/19/2006 and was last updated on 3/29/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistR5H69MISSOURINo
2174400000XSpecialist036-072078ILLINOISNo
3207RN0300XInternal MedicineNephrology036-072078ILLINOISNo
4207RN0300XInternal MedicineNephrologyR5H69MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1036072078MEDICAIDILLINOIS
2202546321MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.