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  7. NPI Record 1427144583

PAVEL POLEHNA MD
Complete NPI Record 1427144583
Family Medicine in Vancouver, WA

NPI Status: Active since October 05, 2006

Contact Information

700 NE 87TH AVE
VANCOUVER, WA
ZIP 98664
Phone: (360) 254-1240
Fax: (360) 397-3128

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Credential Text
  6. Provider First Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Provider Gender Code
  23. Healthcare Provider Taxonomy Code 1
  24. Provider License Number 1
  25. Provider License Number State Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Healthcare Provider Taxonomy Code 2
  28. Provider License Number 2
  29. Provider License Number State Code 2
  30. Healthcare Provider Primary Taxonomy Switch 2
  31. Healthcare Provider Taxonomy Code 3
  32. Provider License Number 3
  33. Provider License Number State Code 3
  34. Healthcare Provider Primary Taxonomy Switch 3
  35. Healthcare Provider Taxonomy Code 4
  36. Provider License Number 4
  37. Provider License Number State Code 4
  38. Healthcare Provider Primary Taxonomy Switch 4
  39. Healthcare Provider Taxonomy Code 5
  40. Provider License Number 5
  41. Provider License Number State Code 5
  42. Healthcare Provider Primary Taxonomy Switch 5
  43. Healthcare Provider Taxonomy Code 6
  44. Provider License Number 6
  45. Provider License Number State Code 6
  46. Healthcare Provider Primary Taxonomy Switch 6
  47. Healthcare Provider Taxonomy Code 7
  48. Provider License Number 7
  49. Provider License Number State Code 7
  50. Healthcare Provider Primary Taxonomy Switch 7
  51. Healthcare Provider Taxonomy Code 8
  52. Provider License Number 8
  53. Provider License Number State Code 8
  54. Healthcare Provider Primary Taxonomy Switch 8
  55. Healthcare Provider Taxonomy Code 9
  56. Provider License Number 9
  57. Provider License Number State Code 9
  58. Healthcare Provider Primary Taxonomy Switch 9
  59. Healthcare Provider Taxonomy Code 10
  60. Provider License Number 10
  61. Provider License Number State Code 10
  62. Healthcare Provider Primary Taxonomy Switch 10
  63. Healthcare Provider Taxonomy Code 11
  64. Provider License Number 11
  65. Provider License Number State Code 11
  66. Healthcare Provider Primary Taxonomy Switch 11
  67. Healthcare Provider Taxonomy Code 12
  68. Provider License Number 12
  69. Provider License Number State Code 12
  70. Healthcare Provider Primary Taxonomy Switch 12
  71. Other Provider Identifier 1
  72. Other Provider Identifier Type Code 1
  73. Other Provider Identifier State 1
  74. Is Sole Proprietor
  75. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1427144583. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1427144583
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: PAVEL
The first name of the provider, if the provider is an individual.
Provider Credential Text: MD
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 700 NE 87TH AVE
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: VANCOUVER
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: WA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 986641913
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 3602541240
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 3603973128
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 700 NE 87TH AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: VANCOUVER
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: WA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 986641913
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 3602541240
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 3603973128
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 10/5/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 4/30/2020
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 207Q00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: MD00047152
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: WA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Healthcare Provider Taxonomy Code 2: 207Q00000X
Provider License Number 2: 113948
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: AK
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 207Q00000X
Provider License Number 3: 51068
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: AZ
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 207Q00000X
Provider License Number 4: M-13199
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4: ID
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 207Q00000X
Provider License Number 5: DR.0056351
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 5: CO
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 5: N
Healthcare Provider Taxonomy Code 6: 207Q00000X
Provider License Number 6: MD-18503
Provider License Number State Code 6: HI
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 207Q00000X
Provider License Number 7: 16301
Provider License Number State Code 7: NV
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 207Q00000X
Provider License Number 8: 10464A
Provider License Number State Code 8: WY
Healthcare Provider Primary Taxonomy Switch 8: N
Healthcare Provider Taxonomy Code 9: 207Q00000X
Provider License Number 9: MD2015-0793
Provider License Number State Code 9: NM
Healthcare Provider Primary Taxonomy Switch 9: N
Healthcare Provider Taxonomy Code 10: 207Q00000X
Provider License Number 10: 41935
Provider License Number State Code 10: MT
Healthcare Provider Primary Taxonomy Switch 10: N
Healthcare Provider Taxonomy Code 11: 207Q00000X
Provider License Number 11: MD162124
Provider License Number State Code 11: OR
Healthcare Provider Primary Taxonomy Switch 11: N
Healthcare Provider Taxonomy Code 12: 207Q00000X
Provider License Number 12: A97249
Provider License Number State Code 12: CA
Healthcare Provider Primary Taxonomy Switch 12: N
Other Provider Identifier 1: 8464547
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: WA
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 4/30/2020