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DAVID BRYAN POLLEY NP
NPI 1205333275
Nurse Practitioner in Andover, MN

Active since April 06, 2018PECOS EnrolledAccepts Medicare Assignment
15245 BLUEBIRD ST NW, ANDOVER, MN 55304(763) 587-4688(763) 587-4662 Get Directions Write a Review

NPPES record last updated: November 23, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 23, 2021, Apr 6, 2021 (2 updates tracked since 2021).

About David Bryan Polley Np NPPES

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

DAVID BRYAN POLLEY NP (NPI 1205333275) is an individual nurse practitioner in Andover, Minnesota, licensed in Minnesota (5741) and active in the NPI registry since April 2018. He is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1205333275
Entity TypeIndividualMale
Primary Taxonomy363L00000X
Provider Legal NameDAVID BRYAN POLLEYCredential: NP
Location Address15245 BLUEBIRD ST NWAndover, MN 55304-3538
Mailing Address8170 33rd Ave S, Ms 21110qBloomington, MN 55425-4516
Phone(763) 587-4688
Fax(763) 587-4662
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateApril 6, 2018
Last NPPES UpdateNovember 23, 20212 updates tracked since enumeration
NPPES CertifiedNovember 23, 2021
✔ NPI 1205333275 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in MN · 5741
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
15245 BLUEBIRD ST NW, Andover, MN 55304
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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

David Bryan Polley 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 ID9032464003
PECOS Enrollment IDI20180614001904
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 David Polley reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Group Health, Inc.
4.7 mi
General Practice
11475 ROBINSON DR NW
Coon Rapids, MN 55433
  • Reassigned Medicare billing, Minnesota enrollment
  • 2,274 clinicians in this Medicare group
NPI 1184779811 (763) 754-0041

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 5

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 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.
73 services67 patients
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.
39 services34 patients
X-ray of chest, 2 views 71046
A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.
18 services13 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
13 services13 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55304 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
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$98.61 typical visit price
range $18.32 – $138.04
Typical copayment $24.65 (range $4.58 – $34.51)
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.

DIVINA FAMA BIKERI CNP
Nurse Practitioner (Family)
15245 BLUEBIRD ST NW
ANDOVER, MN 55304
Anoka County (763) 587-4688
ROMAN P SMULKA MD
Family Medicine
15245 BLUEBIRD ST NW, MAIL STOP 39200A RIVERWAY CLINIC - ANDOVER
ANDOVER, MN 55304
Anoka County (763) 587-4600
BARBARA SCHIEFEN
Nurse Practitioner
15245 BLUEBIRD ST NW, HEALTHPARTNERS RIVERWAY ANDOVER URGENT CARE
ANDOVER, MN 55304
Anoka County (952) 853-8800
KARIN FILIP PAC-C
Physician Assistant
15245 BLUEBIRD ST NW
ANDOVER, MN 55304
Anoka County (763) 587-4688
CHANDRAWATIE KHEMRAJ APRN
Nurse Practitioner
15245 BLUEBIRD ST NW
ANDOVER, MN 55304
Anoka County (763) 587-4688
HELEN C KNUTSON PNP
Nurse Practitioner
15245 BLUEBIRD ST NW, MAIL STOP 39200A
ANDOVER, MN 55304
Anoka County (763) 712-6000
GROUP HEALTH, INC.
Clinic/Center (Multi-Specialty)
15245 BLUEBIRD ST NW
ANDOVER, MN 55304
Anoka County (763) 587-4600
AMY CHERUVATHOOR
Pharmacist
15245 BLUEBIRD ST NW
ANDOVER, MN 55304
Anoka County (763) 434-1901

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 David Polley's NPI number?

The NPI number for David Polley is 1205333275. It was assigned to this individual provider in the NPPES registry on April 6, 2018.

Where is David Polley located?

David Polley practices at 15245 Bluebird St NW, Andover, MN 55304. The listed phone number is (763) 587-4688.

What is David Polley's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is David Polley enrolled in Medicare?

Yes. David Polley is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for David Polley's services?

According to the CMS Revalidation Reassignment List (October 2026 release), David Polley reassigns Medicare benefits to Group Health, Inc. (Coon Rapids, MN). The 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 David Polley's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for David Polley was last updated on November 23, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.