DR. DONOVAN C POLACK MD
NPI 1659324465
Internal Medicine - Nephrology in Florissant, MO

Q: What is Donovan Polack's NPI number?

The NPI number for Donovan Polack is 1659324465. It was assigned to this individual provider in the NPPES registry on May 19, 2006.

Q: What is Donovan Polack's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Q: When was this NPI record last updated?

The NPPES record for Donovan Polack was last updated on May 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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 19, 2006PECOS EnrolledAccepts Medicare Assignment

1265 GRAHAM RD STE 1, FLORISSANT, MO 63031(314) 741-1600(314) 741-1677 Get Directions Write a Review

NPPES record last updated: May 22, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 29, 2021, Oct 29, 2018, Nov 10, 2015 (3 updates tracked since 2015).

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About Dr. Donovan C Polack Md NPPES

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

DR. DONOVAN C POLACK MD (NPI 1659324465) is an individual nephrology provider in Florissant, Missouri, licensed in Missouri (R5H69) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS, is affiliated with Alton Memorial Hospital, and maintains a secondary practice location in Granite City.

NPPES Registry Identity

NPI1659324465

Entity TypeIndividualMale

Primary Taxonomy207RN0300X

Provider Legal NameDR. DONOVAN C POLACKCredential: MD

Location Address1265 GRAHAM RD STE 1Florissant, MO 63031-8018

Mailing Address1265 Graham Rd Ste 1Florissant, MO 63031-8018 · (314) 741-1600 · Fax (314) 741-1677

Phone(314) 741-1600

Fax(314) 741-1677

Sole ProprietorNo

Medical School CMSJs Weill Medical College, Cornell UniversityGraduated 1979

Enumeration DateMay 19, 2006

Last NPPES UpdateMay 22, 20243 updates tracked since enumeration

NPPES CertifiedMay 22, 2024

✔ NPI 1659324465 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians

Taxonomy Code207RN0300X

Licenses✔ Licensed in MO · R5H69✔ Licensed in IL · 036-072078

Definition

An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

Also ListedSpecialistTaxonomy 174400000X · License 036-072078 (IL), R5H69 (MO)

1265 GRAHAM RD STE 1, Florissant, MO 63031

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Secondary Practice Location 1

Location 12044 Madison Ave Ste 15Granite City, IL 62040-4641 · Phone (314) 741-1600 · Fax (314) 741-1677

Other Identifiers 2

Medicaid036072078IL

Medicaid202546321MO

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Insurance Company, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Donovan C Polack Md 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 ID5799692646

PECOS Enrollment IDI20041213000546, I20060720000235

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.

Areas of Expertise CMS Part B claims 7

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

224 services57 patients

Dialysis services, 4 or more physician visits per month (20 years or older) 90960

Dialysis is a treatment that filters and purifies your blood using a machine. It helps keep your fluids and electrolytes in balance when the kidneys can't do their job. This service includes 4 or more visits per month with a physician to monitor your health and adjust your treatment as needed.

111 services28 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.

109 services54 patients

Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

35 services30 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

22 services12 patients

Dialysis services, 2-3 physician visits per month (20 years or older) 90961

Dialysis is a treatment that performs the function of healthy kidneys if they're not working properly. It removes waste and excess fluid from your blood. 2-3 physician visits per month are recommended for monitoring your health and adjusting your treatment as needed. This service is available for those aged 20 years and older.

17 services11 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Alton Memorial Hospital

Acute Care Hospitals · Alton, IL

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140002

LocationOne Memorial DriveAlton, IL 62002 · Madison County

Emergency services Birthing friendly

Gateway Regional Medical Center

Acute Care Hospitals · Granite City, IL

1/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number140125

Location2100 Madison AvenueGranite City, IL 62040 · Madison County

Emergency services

Mercy Hospital Jefferson

Acute Care Hospitals · Festus, MO

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number260023

Location1400 Us Highway 61Festus, MO 63028 · Jefferson County

Emergency services

Ssm Health Depaul Hospital St Louis

Acute Care Hospitals · Bridgeton, MO

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number260104

Location12303 Depaul DriveBridgeton, MO 63044 · St. Louis County

Emergency services Birthing friendly

Christian Hospital Northeast

Acute Care Hospitals · Saint Louis, MO

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number260180

Location11133 Dunn RoadSaint Louis, MO 63136 · St. Louis County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63031 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

$128.28 typical visit price

range $55.65 – $169.38

Typical copayment $32.07 (range $13.91 – $42.34)

Most-billed visit code 99204

Established Patient

$98.37 typical visit price

range $17.76 – $137.92

Typical copayment $24.59 (range $4.44 – $34.48)

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 5

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

DR. NICHOLAS JOHN MAYER D.O.

Internal Medicine (Nephrology)