Individual provider Active NPI

Julia Prokesova, MD

  • Emergency Medicine Physician
  • Willimantic, CT
National Provider Identifier
1972036416
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
71125 Issued in CA
Practice address
112 Mansfield Ave
Willimantic, CT 06226-2045
Phone
(860) 609-9929
NPI assigned
Apr 11, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2020-00206 NC
Emergency Medicine Physician 207P00000X 71125 CA Primary

Addresses

Primary practice location

112 Mansfield Ave
Willimantic, CT 06226-2045

Mailing address

112 Mansfield Ave
Willimantic, CT 06226-2045
Phone (860) 609-9929

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, CT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200624001923 NC Practitioner - Emergency Medicine 2860762903 Reassigns benefits to 2 organizations
I20221110002332 CT Practitioner - Emergency Medicine 2860762903 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Wake Forest University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The William W Backus HospitalGroup PAC ID 0749170645, 248 clinicians

Practice addresses (Care Compare)

326 Washington St
Norwich, CT 06360-2740
Phone (860) 889-8331

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.8 of 100Reported as group
Quality
90
Promoting interoperability
100
Improvement activities
40
Cost
78.43

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
71125CAMDEmergency Medicine Physician
2020-00206NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The William W Backus Hospital CurrentSince Dec 1, 2023 Accepting new patients
William W Backus Hospital CurrentSince Dec 1, 2023 Accepting new patients
Wake Forest University Health Sciences CurrentSince Jul 29, 2020 Accepting new patients
Wake Forest Emergency Providers CurrentSince Jul 1, 2020 Accepting new patients

Locations

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

329 NC Highway 801 N
Bermuda Run, NC 27006
Phone (336) 716-8200

1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000

557 Brookdale Dr
Statesville, NC 28677
Phone (330) 445-4361

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: julia.prokesova@xdr.hhchealthdirect.org

Organizations & group practices 4

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1491868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1972036416",
    "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",
            "telephone_number": "860-609-9929"
        },
        {
            "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": "860-609-9929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROKESOVA",
        "first_name": "JULIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-11",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2020-00206",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "71125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willimantic, CT

Sources for this page

Verify at the official NPI Registry.