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POLLEY CLINIC OF DERMATOLOGY & DERMATOLOGIC SURGERY
NPI 1104847714
Dermatology - Dermatopathology in Wilson, NC

Active since July 21, 2006CLIA Certified · 3 labs
1806 GLENDALE DR SW, WILSON, NC 27893(252) 243-0566(252) 243-1347 Get Directions Write a Review

NPPES record last updated: August 4, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Polley Clinic Of Dermatology & Dermatologic Surgery NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

POLLEY CLINIC OF DERMATOLOGY & DERMATOLOGIC SURGERY (NPI 1104847714) is a healthcare organization registered as a dermatopathology in Wilson, North Carolina and active in the NPI registry since July 2006. The organization holds 3 active CLIA laboratory certificates and lists Kelli Newman, Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1104847714
Entity TypeOrganization
Primary Taxonomy207ND0900X
Legal Business NamePOLLEY CLINIC OF DERMATOLOGY & DERMATOLOGIC SURGERY
Location Address1806 GLENDALE DR SWWilson, NC 27893-4402
Mailing Address1806 Glendale Dr SwWilson, NC 27893-4402 · (252) 243-0566 · Fax (252) 243-1347
Phone(252) 243-0566
Fax(252) 243-1347
Organization SubpartNo
Authorized OfficialKelli NewmanCredentialing Specialist · (252) 668-7026
Enumeration DateJuly 21, 2006
Last NPPES UpdateAugust 4, 2021
NPPES CertifiedAugust 6, 2020
✔ NPI 1104847714 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · DermatopathologyAllopathic & Osteopathic Physicians
Taxonomy Code207ND0900X
License✔ Licensed in NC · 27881
Definition
A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes.
1806 GLENDALE DR SW, Wilson, NC 27893
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Other Identifiers 9

Other0296GNC · Bcbs Of Nc
Other99494NC · Medcost
Other2222414NC · First Health
Other7257619NC · Aetna
Other68327NC · Accordia
OtherDE4848NC · Rail Road Medicare
Other7068303NC · Cigna
Other785505NC · United Health Care
Medicaid890296GNC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of North Carolina and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Polley Clinic Of Dermatology & Dermatologic Surgery is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Polley Clinic Of Dermatology & Dermatologic Surgery, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Dennis Polley, D.O.
Dermatology
NPI 1649291394
1806 GLENDALE DR SW
Wilson, NC 27893
(252) 243-0566
✔ PECOS✔ Accepts MedicareSame address
Amy Cavanagh, MSN, FNP
Nurse Practitioner
NPI 1902856776
3516 US HIGHWAY 301 S
Smithfield, NC 27577
(800) 243-0566
✔ PECOS✔ Accepts Medicare30 mi
Joseph Wilkinson, FNP-BC
Nurse Practitioner
NPI 1588685937
3516 US HIGHWAY 301 S
Smithfield, NC 27577
(800) 243-0566
✔ PECOS30 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2098510

Polley Clinic Of Dermatology · Rocky Mount, NC
Active · expires Jun 20, 2027
CLIA Number34D2098510
Laboratory TypePhysician Office
Certificate Effective DateJune 21, 2025
Certificate Expiration DateJune 20, 2027
Laboratory DirectorDennis C. Polley
Laboratory Phone(252) 243-0566
Laboratory LocationPolley Clinic Of Dermatology131 Foy Drive, Rocky Mount, NC 27804
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D2098514

Polley Clinic Of Dermatology · Goldsboro, NC
Active · expires Jun 20, 2027
CLIA Number34D2098514
Laboratory TypePhysician Office
Certificate Effective DateJune 21, 2025
Certificate Expiration DateJune 20, 2027
Laboratory DirectorDennis C. Polley
Laboratory Phone(252) 243-0566
Laboratory LocationPolley Clinic Of Dermatology1100 East Ash Street, Goldsboro, NC 27530
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D2098517

Polley Clinic Of Dermatology · Fayetteville, NC
Active · expires Jun 20, 2027
CLIA Number34D2098517
Laboratory TypePhysician Office
Certificate Effective DateJune 21, 2025
Certificate Expiration DateJune 20, 2027
Laboratory DirectorDennis C. Polley
Laboratory Phone(252) 243-0566
Laboratory LocationPolley Clinic Of Dermatology110 Barcelona Drive, Fayetteville, NC 28303
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Polley Clinic Of Dermatology & Dermatologic Surgery's NPI number?

The NPI number for Polley Clinic Of Dermatology & Dermatologic Surgery is 1104847714. It was assigned to this organization in the NPPES registry on July 21, 2006.

Where is Polley Clinic Of Dermatology & Dermatologic Surgery located?

Polley Clinic Of Dermatology & Dermatologic Surgery is located at 1806 Glendale Dr SW, Wilson, NC 27893. The listed phone number is (252) 243-0566.

What is Polley Clinic Of Dermatology & Dermatologic Surgery's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Dermatopathology, with taxonomy code 207ND0900X.

Is Polley Clinic Of Dermatology & Dermatologic Surgery enrolled in Medicare?

Yes. Polley Clinic Of Dermatology & Dermatologic Surgery is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Polley Clinic Of Dermatology & Dermatologic Surgery?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Polley Clinic Of Dermatology & Dermatologic Surgery, in Dermatology and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Polley Clinic Of Dermatology & Dermatologic Surgery hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Polley Clinic Of Dermatology & Dermatologic Surgery accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and AmeriHealth Caritas Next and 2 other insurers list Polley Clinic Of Dermatology & Dermatologic Surgery as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Polley Clinic Of Dermatology & Dermatologic Surgery was last updated on August 4, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.