KELLY ANNE POLAK NP
NPI 1114133162
Nurse Practitioner - Family in Scottsdale, AZ

Q: What is Kelly Polak's NPI number?

The NPI number for Kelly Polak is 1114133162. It was assigned to this individual provider in the NPPES registry on May 15, 2007.

Q: What is Kelly Polak's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Polak was last updated on September 25, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.

Active since May 15, 2007PECOS EnrolledAccepts Medicare Assignment

9003 E SHEA BLVD, SCOTTSDALE, AZ 85260(480) 323-3350 Get Directions Write a Review

NPPES record last updated: September 25, 2007. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Kelly Anne Polak Np NPPES

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

KELLY ANNE POLAK NP (NPI 1114133162) is an individual family provider in Scottsdale, Arizona, licensed in Arizona (RN063628) and active in the NPI registry since May 2007. She is enrolled in Medicare PECOS and is a graduate of Other (2003).

NPPES Registry Identity

NPI1114133162

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameKELLY ANNE POLAKCredential: NP

Location Address9003 E SHEA BLVDScottsdale, AZ 85260-6709

Mailing Address13601 W Pinchot AveAvondale, AZ 85392-3552 · (602) 980-4449

Phone(480) 323-3350

Sole ProprietorNo

Medical School CMSOtherGraduated 2003

Enumeration DateMay 15, 2007

Last NPPES UpdateSeptember 25, 2007

✔ NPI 1114133162 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in AZ · RN063628

9003 E SHEA BLVD, Scottsdale, AZ 85260

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter Health, Blue Cross Blue Shield of Arizona and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kelly Anne Polak Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9234274093

PECOS Enrollment IDI20100304000052

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kelly Polak reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Honorhealth Ambulatory

Same address

Cardiovascular Disease

9003 E SHEA BLVD STE HG
Scottsdale, AZ 85260

Reassigned Medicare billing, Arizona enrollment
822 clinicians in this Medicare group

NPI 1023779451 (480) 323-4973

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

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

110 services73 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

13 services12 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85260 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.89 typical visit price

range $55.44 – $168.60

Typical copayment $21.47 (range $13.86 – $42.15)

Most-billed visit code 99203

Established Patient

$98.00 typical visit price

range $17.72 – $137.41

Typical copayment $24.50 (range $4.43 – $34.35)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JAMES POTENZINI

Specialist/Technologist, Other (Electroneurodiagnostic)