Active NPI
Donna Prohazka, MD
- Diagnostic Radiology Physician
- Marshfield, WI
National Provider Identifier
1710907142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 53021
- Practice address
- 1000 N Oak Ave
Marshfield, WI 54449-5703 - Phone
- (715) 387-5511
- NPI assigned
- Jul 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | 117502 | MO | |
| Diagnostic Radiology Physician | 2085R0202X | 117502 | MO | |
| Diagnostic Ultrasound Physician | 2085U0001X | 117502 | MO | |
| Diagnostic Radiology Physician | 2085R0202X | 53021 | WI | Primary |
| Body Imaging Physician | 2085B0100X | 53021 | WI | |
| Diagnostic Ultrasound Physician | 2085U0001X | 53021 | WI |
Addresses
Primary practice location
1000 N Oak Ave
Marshfield, WI 54449-5703
Mailing address
1000 N Oak Ave
Marshfield, WI 54449-5703
Phone (715) 387-5511
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 203840202 | Medicaid | MO | |
| 75030 | Other | HEALTH ALLIANCE | |
| 11377 | Other | ESSENCE | |
| 300092272 | Other | MEDICARE RAILROAD MO | |
| 250846 | Other | HARMONY ID NUMBER | |
| 5106488 | Other | AETNA | |
| 1853 | Other | BLUE CROSS BLUE SHIELD | |
| 434759 | Other | HEALTHLINK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117502 | MO | MD | Body Imaging Physician |
| 53021 | WI | MD | Diagnostic Ultrasound Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rolla Radiology Group, LLC | Diagnostic Radiology | Past | Accepting new patients |
| Cape Radiology Group, P.C. | Diagnostic Radiology | Past | Accepting new patients |
| Bluff Radiology Group, LLC | Diagnostic Radiology | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- Diagnostic Radiology Physician
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-
- Diagnostic Radiology Physician
- Cape Girardeau, MO
- NPI 1477506392
-
- Diagnostic Radiology Physician
- Rolla, MO
- NPI 1780638270
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299715200000",
"number": "1710907142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 N OAK AVE",
"city": "MARSHFIELD",
"state": "WI",
"postal_code": "544495703",
"telephone_number": "715-387-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 N OAK AVE",
"city": "MARSHFIELD",
"state": "WI",
"postal_code": "544495703",
"telephone_number": "715-387-5511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROHAZKA",
"first_name": "DONNA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-20",
"last_updated": "2011-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "MO",
"license": "117502",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MO",
"license": "117502",
"primary": false
},
{
"code": "2085U0001X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Ultrasound",
"state": "MO",
"license": "117502",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "WI",
"license": "53021",
"primary": true
},
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "WI",
"license": "53021",
"primary": false
},
{
"code": "2085U0001X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Ultrasound",
"state": "WI",
"license": "53021",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "203840202",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "75030",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ESSENCE",
"identifier": "11377",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD MO",
"identifier": "300092272",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARMONY ID NUMBER",
"identifier": "250846",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5106488",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "1853",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "434759",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Marshfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.