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POLLY M SEPULVADO M.D.
NPI 1366433781
Internal Medicine in Roseburg, OR

Active since November 03, 2005PECOS Enrolled
150 NE KENNETH FORD DR, ROSEBURG, OR 97470(416) 729-5965(541) 492-2060 Get Directions Write a Review

NPPES record last updated: December 9, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Polly M Sepulvado M.d. NPPES

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

POLLY M SEPULVADO M.D. (NPI 1366433781) is an individual internal medicine provider in Roseburg, Oregon, licensed in Oregon (MD16468) and active in the NPI registry since November 2005. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1366433781
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NamePOLLY M SEPULVADOCredential: M.D.
Location Address150 NE KENNETH FORD DRRoseburg, OR 97470-1042
Mailing Address573 Ne Stephens StRoseburg, OR 97470-3150 · (541) 677-2432 · Fax (541) 957-1131
Phone(416) 729-5965
Fax(541) 492-2060
Sole ProprietorYes
Enumeration DateNovember 3, 2005
Last NPPES UpdateDecember 9, 2024
NPPES CertifiedDecember 9, 2024
✔ NPI 1366433781 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in OR · MD16468
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedInternal Medicine · RheumatologyTaxonomy 207RR0500X · License MD16468 (OR)
150 NE KENNETH FORD DR, Roseburg, OR 97470
Open in Google Maps ↗

Other Identifiers 1

Medicaid005129OR

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Polly M Sepulvado M.d. 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 Polly Sepulvado reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Umpqua Community Health Center, Inc.
Same address
Federally Qualified Health Center (FQHC)
150 KENNETH FORD DR
Roseburg, OR 97470
  • Reassigned Medicare billing, Oregon enrollment
  • 52 clinicians in this Medicare group
NPI 1396751772 (541) 672-9596

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 97470 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
$126.25 typical visit price
range $54.96 – $166.64
Typical copayment $31.56 (range $13.74 – $41.66)
Most-billed visit code 99204
Established Patient
$97.16 typical visit price
range $17.68 – $136.19
Typical copayment $24.29 (range $4.42 – $34.04)
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.

MISHA MARIE PEEL DO
Family Medicine
150 NE KENNETH FORD DR
ROSEBURG, OR 97470
Douglas County (541) 672-9596
DR. JUSTIN L JONES DDS
Dentist (Dental Public Health)
150 NE KENNETH FORD DR
ROSEBURG, OR 97470
Douglas County (541) 672-9596
DR. JOHN TRAVIS MELLING MD
Family Medicine
150 NE KENNETH FORD DR
ROSEBURG, OR 97470
Douglas County (541) 672-9596
ARIELLE FAITH BURNETT DMD
Dentist
150 NE KENNETH FORD DR
ROSEBURG, OR 97470
Douglas County (541) 672-9596
UMPQUA COMMUNITY HEALTH CENTER, INC.
Pharmacy (Community/Retail Pharmacy)
150 NE KENNETH FORD DR
ROSEBURG, OR 97470
Douglas County (541) 672-9596
JORDAN ENDRES DDS
Dentist (General Practice)
150 NE KENNETH FORD DR
ROSEBURG, OR 97470
Douglas County (541) 672-9596
MIRRANDA RENEE MANDERA CHW
Community Health Worker
150 NE KENNETH FORD DR
ROSEBURG, OR 97470
Douglas County (541) 672-9596
DR. OBIAGERI EGEOLU MD
Family Medicine
150 NE KENNETH FORD DR
ROSEBURG, OR 97470
Douglas County (541) 672-9596

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 Polly Sepulvado's NPI number?

The NPI number for Polly Sepulvado is 1366433781. It was assigned to this individual provider in the NPPES registry on November 3, 2005.

Where is Polly Sepulvado located?

Polly Sepulvado practices at 150 NE Kenneth Ford Dr, Roseburg, OR 97470. The listed phone number is (416) 729-5965.

What is Polly Sepulvado's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Polly Sepulvado enrolled in Medicare?

Yes. Polly Sepulvado is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Polly Sepulvado's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Polly Sepulvado reassigns Medicare benefits to Umpqua Community Health Center, Inc. (Roseburg, OR). 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 Polly Sepulvado'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 Polly Sepulvado was last updated on December 9, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months 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.