Active NPI
Steven W Pruett, M.D.
- Diagnostic Radiology Physician
- Rome, GA
National Provider Identifier
1013015544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 045319
- Practice address
- 1104 Martha Berry Blvd NE
Rome, GA 30165-1612 - Phone
- (706) 291-2077
- Fax
- (706) 235-4177
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nuclear Radiology Physician | 2085N0904X | 045319 | GA | |
| Pediatric Radiology Physician | 2085P0229X | 045319 | GA | |
| Diagnostic Radiology Physician | 2085R0202X | 045319 | GA | Primary |
| Diagnostic Ultrasound Physician | 2085U0001X | 045319 | GA |
Addresses
Primary practice location
1104 Martha Berry Blvd NE
Rome, GA 30165-1612
Mailing address
1104 Martha Berry Blvd NE
Rome, GA 30165-1612
Phone (706) 291-2077
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 524527 | Other | GA | BCBS OF GEORGIA |
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 |
|---|---|---|---|
| 045319 | GA | MD | Nuclear Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188950400000",
"number": "1013015544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1104 MARTHA BERRY BLVD NE",
"city": "ROME",
"state": "GA",
"postal_code": "301651612",
"telephone_number": "706-291-2077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1104 MARTHA BERRY BLVD NE",
"city": "ROME",
"state": "GA",
"postal_code": "301651612",
"telephone_number": "706-291-2077",
"fax_number": "706-235-4177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUETT",
"first_name": "STEVEN",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "2085N0904X",
"taxonomy_group": "",
"desc": "Radiology, Nuclear Radiology",
"state": "GA",
"license": "045319",
"primary": false
},
{
"code": "2085P0229X",
"taxonomy_group": "",
"desc": "Radiology, Pediatric Radiology",
"state": "GA",
"license": "045319",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "GA",
"license": "045319",
"primary": true
},
{
"code": "2085U0001X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Ultrasound",
"state": "GA",
"license": "045319",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF GEORGIA",
"identifier": "524527",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rome, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.