NPIMap

Individual provider Active NPI

Alex Merkulov, MD

  • Diagnostic Radiology Physician
  • Farmington, CT
National Provider Identifier
1982868550
Registry record updated Sep 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
48417 Issued in CT
Practice address
263 Farmington Ave
Dignostic Radiology
Farmington, CT 06030-2803
Phone
(860) 679-2784
Fax
(860) 679-4126
NPI assigned
Jul 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 48417 CT Primary

Addresses

Primary practice location

263 Farmington Ave
Dignostic Radiology
Farmington, CT 06030-2803

Mailing address

263 Farmington Ave
Provider Enrollment
Farmington, CT 06030-2212
Phone (860) 679-7503

Other identifiers 1

IdentifierTypeStateIssuer
1982868550MedicaidCT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amerkulov10891@direct.med.uchc.edu

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100727000740 CT Practitioner - Diagnostic Radiology 6901939073 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

263 Farmington Ave
Farmington, CT 06030-0001
Phone (860) 679-3692

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48417CTMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of Connecticut CurrentSince Feb 12, 2020 Accepting new patients
State of Connecticut Current Accepting new patients
University of Connecticut Health Center CurrentSince Apr 19, 2011 Accepting new patients
Uconn Health Imaging, LLC Diagnostic Radiology CurrentSince Apr 17, 2024 Accepting new patients
University of Connecticut Health Center Diagnostic Radiology CurrentSince Apr 19, 2011 Accepting new patients
State of Connecticut CurrentSince Feb 12, 2020 Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Locations

263 Farmington Ave
Farmington, CT 06030
Phone (860) 679-4477

5 Munson Rd
Ste 110
Farmington, CT 06032
Phone (860) 679-2800

850 Bolton Rd
Storrs Mansfield, CT 06269
Phone (860) 486-2629

Interoperability endpoints

  • Direct secure messaging: amerkulov10891@direct.med.uchc.edu

Organizations & group practices 7

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.

Hospital & facility affiliations 2

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": "1215993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1982868550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060302212",
            "telephone_number": "860-679-7503",
            "fax_number": "860-679-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "address_2": "DIGNOSTIC RADIOLOGY",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060302803",
            "telephone_number": "860-679-2784",
            "fax_number": "860-679-4126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERKULOV",
        "first_name": "ALEX",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-14",
        "last_updated": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CT",
            "license": "48417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982868550",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amerkulov10891@direct.med.uchc.edu",
            "affiliation": "N",
            "address_1": "Uconn Medical Group",
            "address_2": "263 Farmington Avenue",
            "city": "Farmington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060300001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.