David Allen Polstra, ACNPC-AG is a medicare enrolled "General Acute Care Hospital" in Los Angeles, California. His current practice location is
1401 S Grand Ave, Los Angeles, California. You can reach out to his office (for appointments etc.) via phone at
(213) 748-2411.
David Allen Polstra is licensed to practice in California (license number 95009210) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1598251498.
Provider's Profile
| Full Name | David Allen Polstra |
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| Gender | Male |
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| Speciality | General Acute Care Hospital |
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| Location | 1401 S Grand Ave, Los Angeles, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1598251498
- Provider Enumeration Date: 07/03/2018
- Last Update Date: 10/20/2023
Medicare PECOS Information:
- PECOS PAC ID: 8628425220
- Enrollment ID: I20231102003761
Medical Identifiers
Medical identifiers for David Allen Polstra such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1598251498 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363L00000X | Nurse Practitioner | AP61493227 (Washington) | Secondary |
| 282N00000X | General Acute Care Hospital | 95009210 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. David Allen Polstra allows following entities to bill medicare on his behalf.
| Entity Name | South Sound Inpatient Physicians Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1023285756
PECOS PAC ID: 5991618738
Enrollment ID: O20031107000668 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. David Allen Polstra is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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David Allen Polstra, ACNPC-AG
2127 Camorilla Dr,
Los Angeles, CA 90065-3401
Ph: (323) 907-9895 | David Allen Polstra, ACNPC-AG
1401 S Grand Ave,
Los Angeles, CA 90015-3010
Ph: (213) 748-2411 |
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