MAXWELL CLARK POLING (PA-C) – Physician Assistant, NPI 1871039727
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
9,231 PHYSICIAN ASSISTANT in FL
Provider Addresses for MAXWELL CLARK POLING (PA-C)
6545 N Wickham Rd Ste 102
Melbourne, FL 329402042
Phone: (321) 395-3298
Fax: (321) 241-1161
Type: Location
1301 Plantation Island Dr S
Ste 106B
Saint Augustine, FL 320803108
Phone: (904) 342-7769
Fax: (904) 342-7770
Type: Location
2305 VIDINA DR STE 102
MELBOURNE, FL 329408066
Phone: (321) 441-8332
Fax: (321) 319-4931
Type: Location
6559 N Wickham Rd Ste C-105
Melbourne, FL 329402052
Phone: (321) 395-3298
Fax: (321) 241-1161
Type: Location
801 YORK ST
MANITOWOC, WI 542204630
Phone: (920) 663-9008
Fax: (904) 342-7770
Type: Mailing
420 5TH AVE
INDIALANTIC, FL 329034280
Phone: (321) 312-1352
Fax: (321) 312-1513
Type: Location
PO BOX 3044
SAINT AUGUSTINE, FL 320853044
Phone: (904) 342-7765
Fax: (904) 342-7770
Type: Mailing
1301 PLANTATION ISLAND DR S
STE 106B
SAINT AUGUSTINE, FL 320803108
Phone: (904) 342-7769
Fax: (904) 342-7770
Type: Location
6545 N Wickham Rd Ste 101
Melbourne, FL 329402042
Phone: (321) 395-3298
Fax: (321) 241-1161
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 137 Open Payments records for all available years, with a total value of $81,041.
Total Amount is formed as General ($81,041) + Research ($0) + Ownership ($0) = $81,041.
Last reported payment date: 2024-12-24 • Largest payer in this snapshot: Galderma Laboratories, L.P. ($79,684).
Total Amount
$81,041
General + Research + Ownership
Payments
137
Total payment records
General Amount
$81,041
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-24
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Galderma Laboratories, L.P. | $79,684 |
| ABBVIE INC. | $645 |
| Merz North America, Inc. | $366 |
| REVANCE THERAPEUTICS, INC. | $208 |
| MERZ NORTH AMERICA, INC. | $89 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-11-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20171102002114 | I | Physician Assistant | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 120 | 31 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 58 | 51 | $0 |
| 11103 | Biopsy of related skin growth, each additional growth | 43 | 26 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 43 | 41 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 41 | 36 | $0 |
Insurance plans in this area (ZIP 32940)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WI | |
| Physician Assistant | VA | |
| - | VA | |
| D E R M A T O L O G Y | TX | |
| - | WI | |
| D E R M A T O L O G Y | AL | |
| D E R M A T O L O G Y | WI | |
| - | WI | |
| Physician Assistant | NY | |
| D E R M A T O L O G Y | WA |
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