Poornima Jayaprakash

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4048 Issued in WI

Practice address

6218 Washington Ave
Suite C
Racine, WI 53406-3916

Phone

(262) 886-1300

Fax

(262) 886-1837

NPI assigned

Jan 1, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417014572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6218 WASHINGTON AVE",
            "address_2": "SUITE C",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534063916",
            "telephone_number": "262-886-1300",
            "fax_number": "262-886-1837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6218 WASHINGTON AVE",
            "address_2": "SUITE C",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534063916",
            "telephone_number": "262-886-1300",
            "fax_number": "262-886-1837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAYAPRAKASH",
        "first_name": "POORNIMA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fatima F Jallow, LPN
• James E. Luetzow, D.D.S., S.C.
• Goran Jankovic, DO
• Jeffrey M Janosik
• Tai Jaranson, PHARMD
• Subbanna Jayaprakash, M.D.
• Lorice Jean
• Jill Jelinek, L.AC.
• Jodi Mari Jensen, L.B.T.
• Marianne T. Jensen, MSW

• General Practice Dentistry in Racine, WI
• Providers in Racine, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.