KEVIN L POLGLAZE (DO) – Emergency Medicine Physician, NPI 1053555367
Emergency Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
1,309 EMERGENCY MEDICINE in WI
Provider Addresses for KEVIN L POLGLAZE (DO)
2845 Greenbrier Rd
Green Bay, WI 543116519
Phone: (920) 490-9046
Type: Location
PO box, Russell Road, Paoli, Tredyffrin Township, Chester County, Pennsylvania, 19301, United States
GREEN BAY, WI 543240900
Phone: (920) 490-9046
Fax: (920) 405-5388
Type: Mailing
Aurora Medical Center, 855, North Westhaven Drive, Oshkosh, Winnebago County, Wisconsin, 54904, United States
OSHKOSH, WI 549047668
Phone: (920) 490-9046
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2009-07-07
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 |
|---|---|---|---|---|
| I20090707000664 | I | Emergency Medicine | WI | 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 |
|---|---|---|---|---|
| 99285 | Emergency department visit with high level of medical decision making | 109 | 102 | $0 |
| 99284 | Emergency department visit with moderate level of medical decision making | 65 | 63 | $0 |
| 99291 | Critical care, first 30-74 minutes | 26 | 26 | $0 |
| 99283 | Emergency department visit with low level of medical decision making | 14 | 14 | $0 |
Insurance plans in this area (ZIP 54311)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Emergency Medicine | WI | |
| Physician Assistant | WI | |
| Emergency Medicine | WI | |
| Emergency Medicine | WV | |
| Emergency Medicine | WI | |
| Emergency Medicine | WI | |
| Emergency Medicine | WI | |
| Emergency Medicine | WI | |
| Physician Assistant | WI | |
| Emergency Medicine | OR |
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