LISA SARA POLON PSY.D.
NPI 1366879967
Psychologist - Clinical in Santa Rosa, CA

Q: What is Lisa Polon's NPI number?

The NPI number for Lisa Polon is 1366879967. It was assigned to this individual provider in the NPPES registry on September 27, 2013.

Q: What is Lisa Polon's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Lisa Polon was last updated on May 29, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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 September 27, 2013PECOS EnrolledAccepts Medicare Assignment

3569 ROUND BARN CIR, SANTA ROSA, CA 95403(707) 303-3600 Get Directions Write a Review

NPPES record last updated: May 29, 2020. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Lisa Sara Polon Psy.d. NPPES

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

LISA SARA POLON PSY.D. (NPI 1366879967) is an individual clinical provider in Santa Rosa, California, licensed in California (PSY29914) and active in the NPI registry since September 2013. She is enrolled in Medicare PECOS and is a graduate of Other (1994).

NPPES Registry Identity

NPI1366879967

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameLISA SARA POLONCredential: PSY.D.

Location Address3569 ROUND BARN CIRSanta Rosa, CA 95403-5781

Mailing Address3569 Round Barn CirSanta Rosa, CA 95403-5781 · (707) 303-3600

Phone(707) 303-3600

Sole ProprietorNo

Medical School CMSOtherGraduated 1994

Enumeration DateSeptember 27, 2013

Last NPPES UpdateMay 29, 2020

NPPES CertifiedMay 29, 2020

✔ NPI 1366879967 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in CA · PSY29914

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

3569 ROUND BARN CIR, Santa Rosa, CA 95403

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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

Lisa Sara Polon Psy.d. 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 ID6305285529

PECOS Enrollment IDI20240419001876

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 Reassignments

Medicare enrollment records show Lisa Polon reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Santa Rosa Community Health Centers

Same address

Federally Qualified Health Center (FQHC)

3569 ROUND BARN CIRCLE
Santa Rosa, CA 95403

Reassigned Medicare billing, California enrollment
215 clinicians in this Medicare group

NPI 1578631172 (707) 303-3600

Providence Medical Foundation

3.0 mi

Internal Medicine

500 DOYLE PARK DR, SUITE 303
Santa Rosa, CA 95405

Reassigned Medicare billing, California enrollment
1,699 clinicians in this Medicare group

NPI 1740584473 (707) 303-8300

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 95403 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

$187.01 typical visit price

range $63.04 – $187.01

Typical copayment $46.75 (range $15.76 – $46.75)

Most-billed visit code 99205

Established Patient

$109.88 typical visit price

range $21.02 – $153.40

Typical copayment $27.47 (range $5.25 – $38.35)

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.

DR. LYMAN BOWEN GREAVES JR. M.D.

Family Medicine

3569 ROUND BARN CIR
SANTA ROSA, CA 95403

Sonoma County (707) 303-3600

KYLE RANSOM D.O.

Family Medicine

3569 ROUND BARN CIR
SANTA ROSA, CA 95403

Sonoma County (707) 303-3600

ELIZABETH VIRGINIA FERNWOOD

Nurse Practitioner

3569 ROUND BARN CIR
SANTA ROSA, CA 95403

Sonoma County (707) 303-3600

MOLLIE SCHRODI PMHNP-BC

Nurse Practitioner (Psychiatric/Mental Health)

3569 ROUND BARN CIR
SANTA ROSA, CA 95403

Sonoma County (707) 303-3600

KAYLA FLORES TINDALL

Family Medicine

3569 ROUND BARN CIR, SUITE 200
SANTA ROSA, CA 95403

Sonoma County (707) 583-8800

STEPHEN P KRUMLAND M.D.

Family Medicine

3569 ROUND BARN CIR
SANTA ROSA, CA 95403

Sonoma County (707) 303-3600

CONSUELO SANDOVAL CABRERA

Counselor (Professional)

3569 ROUND BARN CIR
SANTA ROSA, CA 95403

Sonoma County (707) 303-3600

PATRICIA G PADILLA-NOAH MD

Family Medicine

3569 ROUND BARN CIR
SANTA ROSA, CA 95403

Sonoma County (707) 303-3600

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 Lisa Polon's NPI number?

The NPI number for Lisa Polon is 1366879967. It was assigned to this individual provider in the NPPES registry on September 27, 2013.

Where is Lisa Polon located?

Lisa Polon practices at 3569 Round Barn Cir, Santa Rosa, CA 95403. The listed phone number is (707) 303-3600.

What is Lisa Polon's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Lisa Polon enrolled in Medicare?

Yes. Lisa Polon 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 organizations bill Medicare for Lisa Polon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Lisa Polon reassigns Medicare benefits to 2 organizations: Santa Rosa Community Health Centers (Santa Rosa, CA) and Providence Medical Foundation (Santa Rosa, CA). Each 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 Lisa Polon'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 Lisa Polon was last updated on May 29, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.