Polly S Vaughan, CRNP in Wilmington, OH - Medicare Nurse Practitioner

Polly S Vaughan, CRNP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Wilmington, Ohio. She graduated from nursing school in 2007 and has 19 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Kettering Independent Medical Group Inc and her current practice location is 140 Fairway Dr, Wilmington, Ohio. You can reach out to her office (for appointments etc.) via phone at (937) 974-5591.

Polly S Vaughan is licensed to practice in Ohio (license number APRN.CNP.09551) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1063609287.

Contact Information

	Polly S Vaughan, CRNP
	140 Fairway Dr, Wilmington, OH 45177-8008
	(937) 974-5591
	(937) 730-0023

Map and Direction

Provider's Profile

Full Name	Polly S Vaughan
Gender	Female
Speciality	Nurse Practitioner
Experience	19 Years
Location	140 Fairway Dr, Wilmington, Ohio
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Polly S Vaughan graduated from nursing school in 2007

NPI Data:

NPI Number: 1063609287
Provider Enumeration Date: 10/02/2007
Last Update Date: 05/17/2026

Medicare PECOS Information:

PECOS PAC ID: 3375625320
Enrollment ID: I20080129000682

Medical Identifiers

Medical identifiers for Polly S Vaughan such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1063609287	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	APRN.CNP.09551 (Ohio)	Primary
363LF0000X	Nurse Practitioner - Family	APRN.CNP.09551 (Ohio)	Secondary
363LP0200X	Nurse Practitioner - Pediatrics	NP-09551 (Ohio)	Secondary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Kettering Medical Center - Sycamore	Miamisburg, OH	Hospital

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. Polly S Vaughan allows following entities to bill medicare on her behalf.

Entity Name	Family Service Association
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1063442390 PECOS PAC ID: 7618948423 Enrollment ID: O20040804001481

Entity Name	Kettering Independent Medical Group Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1629387865 PECOS PAC ID: 3173710936 Enrollment ID: O20101207000425

Entity Name	Fairway Behavioral Health, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1780328344 PECOS PAC ID: 1951787332 Enrollment ID: O20221008000405

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. Polly S Vaughan 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
Polly S Vaughan, CRNP 6100 Gurneyville Rd, Wilmington, OH 45177-6508 Ph: (937) 313-4400	Polly S Vaughan, CRNP 140 Fairway Dr, Wilmington, OH 45177-8008 Ph: (937) 974-5591

Reviews and Comments

Nurse Practitioner Nurses in Wilmington, OH

Ross S Wickstrom, CNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1184 W Locust St, Wilmington, OH 45177 Phone: 937-382-1616
Ms. Margaret M Brausch, CRNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1184 W Locust St, Wilmington, OH 45177 Phone: 937-382-1616 Fax: 937-382-7877
Tiffany Burroughs, CNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1184 W Locust St, Wilmington, OH 45177 Phone: 937-382-1616 Fax: 937-382-7877
Mrs. Jacquelynn R Mcconnaughey, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2107 Rombach Ave, Wilmington, OH 45177 Phone: 937-383-1040
Sandy W Neville, C.N.P. Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1184 W Locust St, Wilmington, OH 45177 Phone: 937-382-1616
Jason Christian Jones, C.N.P. Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 610 Main Street, Wilmington, OH 45177 Phone: 513-865-2246 Fax: 513-865-5596

Polly S Vaughan, CRNP - Medicare Nurse Practitioner in Wilmington, OH