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Deactivated NPI 1710973698 Deactivated / Inactive NPI Male Practitioner

Dr. Prido J Polanco , MD

General Practice • Bisbee, AZ

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Prido Polanco has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 26, 2005
NPI Deactivation Date December 12, 2018
Total Practice Duration ~13 Years of Practice (2005 – 2018)

Professional Overview & Biography Verified Profile Summary

Dr. Prido Polanco, MD was a registered General Practice practicing in Bisbee, AZ. Throughout an active medical career spanning 13 years, Dr. Polanco provided care at the practice location at 101 COLE AVE until profile deactivation on 2018-12-12.

Historical Medicare Part B clinical services included follow-up hospital inpatient care per day, hospital discharge day management, more than, initial hospital care with moderate level of medical decision making, if using time, at least. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

101 Cole Ave

Bisbee, AZ 856031327

Telephone 5204326481
Fax 5204325082
Associated Practice Facility / Clinic
🏢 Bisbee Hospital Association Facility NPI 1518968767

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Bisbee, AZ

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 21.3 Yrs
Regional Practice Density
2 Specialists

Practicing in Bisbee, AZ (259 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
69.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2018)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99231 Follow-up hospital inpatient care per day, typically 15 minutes
25 11 $122.85 $37.35

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License AZ 13131

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners
Jean Robidoux , PNP

Registered Nurse - Pediatrics

NPI 1295721306

Pediatric Nurse Practitioner

Dr. Scott Slagis , MD

Orthopaedic Surgery

NPI 1407857196

Doctor of Medicine (M.D.)

Nicole Chavez , NP

Nurse Practitioner - Family

NPI 1437395092

Nurse Practitioner

Kathy Griesemer , PA-C

Physician Assistant

NPI 1639165822

Physician Assistant (Certified)

Matthew Johnson , PA

Physician Assistant

NPI 1669607800

Physician Assistant

NPI 1992577134

Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated December 12, 2018

Record deactivated on December 12, 2018

NPI Profile Active February 27, 2013

NPI status registered as active in NPPES database

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Updated Practice Location February 27, 2013

Registered at 101 COLE AVE, BISBEE, AZ 856031327 (Tel: 5204326481)

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Updated Business Mailing Address February 27, 2013

Registered at 101 COLE AVE, BISBEE, AZ 856031327 (Tel: 5204326481)

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Provider Name / Credentials Updated February 27, 2013

Recorded as PRIDO POLANCO, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 27, 2013

General Practice (License #13131 in AZ)

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Initial NPI Registration & Enumeration September 26, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1710973698
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 26, 2005
Last Update: February 27, 2013
Deactivation Date: December 12, 2018

Mailing Address

101 Cole Ave

Bisbee, AZ 856031327

Phone: 5204326481

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.