Rachael Marie Polak, ACNP - Medicare Nurse Practitioner in Dayton, OH

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Rachael Marie Polak, ACNP is a medicare enrolled "Nurse Practitioner - Gerontology" in Dayton, Ohio. Her current practice location is 405 W Grand Ave, Dayton, Ohio. You can reach out to her office (for appointments etc.) via phone at (937) 723-3841.

Rachael Marie Polak is licensed to practice in Ohio (license number APRN.CNP.0031107) 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 1346882974.

Contact Information

Rachael Marie Polak, ACNP
405 W Grand Ave,
Dayton, OH 45405-7538
(937) 723-3841
(937) 723-4209

Map and Direction




Provider's Profile

Full NameRachael Marie Polak
GenderFemale
SpecialityNurse Practitioner - Gerontology
Location405 W Grand Ave, Dayton, Ohio
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1346882974
  • Provider Enumeration Date: 10/15/2019
  • Last Update Date: 05/05/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 9234563420
  • Enrollment ID: I20220408001334

Medical Identifiers

Medical identifiers for Rachael Marie Polak such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1346882974NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LA2100XNurse Practitioner - Acute Care 856862 (Texas)Secondary
363LG0600XNurse Practitioner - Gerontology APRN.CNP.0031107 (Ohio)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. Rachael Marie Polak allows following entities to bill medicare on her behalf.
Entity NameAlliance Physicians Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1437125572
PECOS PAC ID: 0840104360
Enrollment ID: O20031118000529
Entity NameKettering Independent Medical Group Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1629387865
PECOS PAC ID: 3173710936
Enrollment ID: O20101207000425

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. Rachael Marie Polak 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 AddressPractice Location Address
Rachael Marie Polak, ACNP
1 Prestige Pl Ste 550,
Miamisburg, OH 45342-6115

Ph: (937) 762-1305		Rachael Marie Polak, ACNP
405 W Grand Ave,
Dayton, OH 45405-7538

Ph: (937) 723-3841

Reviews and Comments


Nurse Practitioner Nurses in Dayton, OH

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Kimberly Kay Myers, N.P.
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Phone: 937-438-5954    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.