NPIMap

Individual provider Active NPI

Keith Prouty, PHMD

  • Pharmacist
  • Medina, NY
National Provider Identifier
1003223793
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
059304 Issued in NY
Practice address
142 E Center St
Medina, NY 14103-1621
Phone
(585) 798-1212
Fax
(585) 798-2041
NPI assigned
Jul 15, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 059304 NY Primary

Addresses

Primary practice location

142 E Center St
Medina, NY 14103-1621

Mailing address

142 E Center St
Medina, NY 14103-1621
Phone (585) 798-1212

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
059304NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Paul R Grout Past Accepting new patients
Prescription Center of Medina, LLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405382400000",
    "number": "1003223793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 E CENTER ST",
            "city": "MEDINA",
            "state": "NY",
            "postal_code": "141031621",
            "telephone_number": "585-798-1212",
            "fax_number": "585-798-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 E CENTER ST",
            "city": "MEDINA",
            "state": "NY",
            "postal_code": "141031621",
            "telephone_number": "585-798-1212",
            "fax_number": "585-798-2041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROUTY",
        "first_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "PHMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-15",
        "last_updated": "2014-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "059304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.