MR. ILIR POLOVINA NP-C
NPI 1952540999
Nurse Practitioner in Saint Louis, MO
NPI Status: Active since February 16, 2009
Contact Information
12345 W BEND DR STE 200
SAINT LOUIS, MO
ZIP 63128
Phone: (314) 843-8000
Fax: (314) 843-3004
- Individual
- Male
- Nurse Practitioner
- Accepts Insurance
- PECOS Enrolled
- Medicare Quality Reporting
About ILIR POLOVINA
This page provides the complete NPI Profile along with additional information for Ilir Polovina, a provider established in Saint Louis, Missouri with a medical specialization in Nurse Practitioner. The healthcare provider is registered in the NPI registry with number 1952540999 assigned on February 2009. The practitioner's primary taxonomy code is 363L00000X with license number 2003005393 (MO). The provider is registered as an individual and his NPI record was last updated 16 years ago.
- NPI
- 1952540999
- Provider Name
- MR. ILIR POLOVINA NP-C
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 12345 W BEND DR STE 200 SAINT LOUIS, MO 63128
- Location Phone
- (314) 843-8000
- Location Fax
- (314) 843-3004
- Mailing Address
- 12345 W BEND DR STE 200 SAINT LOUIS, MO 63128
- Mailing Phone
- (314) 843-8000
- Mailing Fax
- (314) 843-3004
- Is Sole Proprietor?
- No
- Enumeration Date
- 02-16-2009
- Last Update Date
- 02-16-2009
- Code Navigator
A nurse practitioner (NP) like Ilir Polovina is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner
- Taxonomy Code
- 363L00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 2003005393
- License State
- MO
- Taxonomy Description
- (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Bronze Standard (No Referrals) - EPO
- UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - EPO
- UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - EPO
- UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - EPO
- UHC Gold Standard (No Referrals) - EPO
- UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - EPO
- UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - EPO
- UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Silver Standard (No Referrals) - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Ilir Polovina is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Follow-up hospital inpatient care per day, typically 15 minutes
Follow-up hospital inpatient care per day, typically 25 minutes
Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
This service was performed 125 times for 58 patientsFollow-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.
This service was performed 185 times for 59 patientsPhysician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 63128 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $86.32
- Minimum New Patient Price $55.65
- Maximum New Patient Price $169.38
- Average New Patient Copayment $21.58
- Minimum New Patient Copayment $13.91
- Maximum New Patient Copayment $42.34
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $98.37
- Minimum Established Patient Price $17.76
- Maximum Established Patient Price $137.92
- Average Established Patient Copayment $24.59
- Minimum Established Patient Copayment $4.44
- Maximum Established Patient Copayment $34.48
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Quality Reporting
The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Care Plan | 88% | 24 |
| Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan | ||
Reviews for MR. ILIR POLOVINA NP-C
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 9 | 5 | 2 | 5 | 4 | 0 | 9 | 9 | 9 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 9 | 10 | 2 | 10 | 4 | 0 | 9 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 9 + 1 + 0 + 2 + 1 + 0 + 4 + 0 + 9 + 1 + 8 + 24 = 61 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 61 = 9 | 9 | ||||||||
The NPI number 1952540999 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following provider is registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1578944245 | MRS. JESSICA LAUREN JOHNSTON NP-C Individual | Nurse Practitioner | 12345 W BEND DR STE 200 SAINT LOUIS, MO 63128 (314) 843-8000 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1952540999, enumerated in the NPI registry as an "individual" on February 16, 2009
The provider is located at 12345 W Bend Dr Ste 200 Saint Louis, Mo 63128 and the phone number is (314) 843-8000
The provider's speciality is Nurse Practitioner with taxonomy code 363L00000X
The provider might be accepting Accepts: UnitedHealthcare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $86.32 with an average copayment of $21.58 for new patient appointments. Established patients should expect a typical charge of $98.37 and an average copayment of 24.59. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Follow-up hospital inpatient care per day, typically 15 minutes and Follow-up hospital inpatient care per day, typically 25 minutes.
This NPI record was last updated on February 16, 2009. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.