Mrs Shantell Polidor, APRN in Jacksonville, FL

Mrs Shantell Polidor, APRN is a medicare enrolled "Nurse Practitioner - Family" in Jacksonville, Florida. Her current practice location is 5752 Rover Dr, Jacksonville, Florida. You can reach out to her office (for appointments etc.) via phone at (904) 713-7428.

Mrs Shantell Polidor is licensed to practice in Florida (license number APRN11018822) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1770233579.

Contact Information

	Mrs Shantell Polidor, APRN
	5752 Rover Dr, Jacksonville, FL 32244-1430
	(904) 713-7428
	Not Available

Map and Direction

Provider's Profile

Full Name	Mrs Shantell Polidor
Gender	Female
Speciality	Nurse Practitioner - Family
Location	5752 Rover Dr, Jacksonville, Florida
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1770233579
Provider Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022

Medicare PECOS Information:

PECOS PAC ID: 9739561689
Enrollment ID: I20220809001973

Medical Identifiers

Medical identifiers for Mrs Shantell Polidor such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1770233579	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	APRN11018822 (Florida)	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. Mrs Shantell Polidor allows following entities to bill medicare on her behalf.

Entity Name	Jacksonville Hospitalists Pa
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1871535492 PECOS PAC ID: 3274591631 Enrollment ID: O20041231000013

Entity Name	St Vincent's Ambulatory Care Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1417987124 PECOS PAC ID: 2860411188 Enrollment ID: O20051116000430

Entity Name	Cardiac Vision Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1144651373 PECOS PAC ID: 9032349733 Enrollment ID: O20140225001134

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. Mrs Shantell Polidor 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
Mrs Shantell Polidor, APRN 5752 Rover Dr, Jacksonville, FL 32244-1430 Ph: (904) 713-7428	Mrs Shantell Polidor, APRN 5752 Rover Dr, Jacksonville, FL 32244-1430 Ph: (904) 713-7428

Reviews and Comments

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Mrs Shantell Polidor, APRN - Medicare Nurse Practitioner in Jacksonville, FL