Jessica Lise Vercruysse, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

70713 Issued in CT

Practice address

112 Mansfield Ave
Willimantic, CT 06226-2045

Phone

(904) 265-6850

NPI assigned

Jun 28, 2019

Last updated

Jun 22, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

96.05 of 100Reported as group

Quality

84.92

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

84.01 of 100Reported as group

Quality

71.79

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nems PLLC

  • Emergency Medicine Physician
  • Meriden, CT
  • NPI 1114482882
  Medicare reassignment NPD
• Northeast Emergency Medicine Specialists, LLC

  • Emergency Medicine Physician
  • Willimantic, CT
  • NPI 1982889598
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1033771126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 MANSFIELD AVE",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 MANSFIELD AVE",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262045",
            "telephone_number": "904-265-6850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERCRUYSSE",
        "first_name": "JESSICA",
        "middle_name": "LISE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-28",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4351045618",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "70713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Vanscoy
• Heather S Vasquez
• Bartholomew J Vazquez, FNP-BC
• Leonor Vazquez, LCSW
• Michelle E Vekeman
• James D Votaw, LPC
• Walgreen Eastern Co Inc (Walgreens #07333)
• John D Walker, CPED
• Audie Riley Walters, PTA
• Ellen Waltman, LPC

• Emergency Medicine Physician in Willimantic, CT
• Providers in Willimantic, CT by specialty
• Emergency Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.