Subject Numbers Regarding Health Provider Authorizations

Authorization No. 239371-8B

May 22, 2019

Please be advised that Dr. Sapan K. Polepalle has resigned his authorizations to treat injured workers and to perform independent medical examinations in the New York State workers’ compensation system effective May 17, 2019. Dr. Polepalle’s last known practice addresses are:

Metro Lithotriptor Associates
160 East 32nd Street, Suite 101
New York, New York 10016

Metro Lithotriptor Utopia Center
176-60 Union Turnpike, Suite 200
Fresh Meadows, New York 11366

1 Oak Way, Scarsdale
New York 10583 and

1870 Grand Concourse
Bronx, New York 10457

Dr. Polepalle is prohibited from rendering treatment and care to injured workers, from performing independent medical examinations, and from conducting reviews of records regarding variance requests pursuant to 12 NYCRR § 324.3(b)(2)(ii)(a). Reports submitted by Dr. Polepalle for services rendered prior to May 17, 2019, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Polepalle for services rendered prior to May 17, 2019, should not be denied due to the resignation of his authorizations.

Any questions regarding the authorized lists should be referred to the Medical Director’s Office at 1 (800) 781-2362.