RACHAEL MARIE POLAK ACNP
NPI 1346882974
Nurse Practitioner - Gerontology in Dayton, OH

Q: What is Rachael Polak's NPI number?

The NPI number for Rachael Polak is 1346882974. It was assigned to this individual provider in the NPPES registry on October 15, 2019.

Q: What is Rachael Polak's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Q: When was this NPI record last updated?

The NPPES record for Rachael Polak was last updated on May 5, 2022. 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.

Active since October 15, 2019PECOS Enrolled

405 W GRAND AVE, DAYTON, OH 45405(937) 723-3841(937) 723-4209 Get Directions Write a Review

NPPES record last updated: May 5, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 5, 2022, Oct 16, 2019 (2 updates tracked since 2019).

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About Rachael Marie Polak Acnp NPPES

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

RACHAEL MARIE POLAK ACNP (NPI 1346882974) is an individual gerontology provider in Dayton, Ohio, licensed in Ohio (APRN.CNP.0031107) and active in the NPI registry since October 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1346882974

Entity TypeIndividualFemale

Primary Taxonomy363LG0600X

Provider Legal NameRACHAEL MARIE POLAKCredential: ACNP

Location Address405 W GRAND AVEDayton, OH 45405-7538

Mailing Address1 Prestige Pl Ste 550Miamisburg, OH 45342-6115 · (937) 762-1305 · Fax (937) 522-7513

Phone(937) 723-3841

Fax(937) 723-4209

Sole ProprietorNo

Enumeration DateOctober 15, 2019

Last NPPES UpdateMay 5, 20222 updates tracked since enumeration

NPPES CertifiedMay 5, 2022

✔ NPI 1346882974 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

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

Taxonomy Code363LG0600X

License✔ Licensed in OH · APRN.CNP.0031107

Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X · License 856862 (TX)

405 W GRAND AVE, Dayton, OH 45405

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource, Molina Healthcare 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 (PECOS)

Rachael Marie Polak Acnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Rachael Polak reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Kettering Independent Medical Group Inc

9.5 mi

Orthopaedic Surgery

1 PRESTIGE PL, SUITE 910
Miamisburg, OH 45342

Reassigned Medicare billing, Ohio enrollment
984 clinicians in this Medicare group

NPI 1629387865 (937) 762-1629

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45405 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

$84.72 typical visit price

range $54.34 – $166.65

Typical copayment $21.18 (range $13.58 – $41.66)

Most-billed visit code 99203

Established Patient

$96.44 typical visit price

range $17.10 – $135.40

Typical copayment $24.11 (range $4.27 – $33.85)

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.

LARA MARTINEZ

Emergency Medicine