Active NPI
Ronald Ethan Prater
- Pharmacotherapy Pharmacist
- Bristol, TN
National Provider Identifier
1033713169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 41545
- Practice address
- 308 E Cedar St
Bristol, TN 37620-3928 - Phone
- (423) 968-7983
- NPI assigned
- Nov 30, 2020
- Last updated
- Nov 30, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 0202216140 | VA | |
| Pharmacotherapy Pharmacist | 1835P1200X | 41545 | TN | Primary |
Addresses
Primary practice location
308 E Cedar St
Bristol, TN 37620-3928
Mailing address
308 E Cedar St
Bristol, TN 37620-3928
Phone (423) 968-7983
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
| License | State | Type | Specialty |
|---|---|---|---|
| 41545 | TN | MD | Pharmacotherapy Pharmacist |
| 0202216140 | VA | MD | Pharmacotherapy Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tennessee CVS Pharmacy LLC | Past | Accepting new patients | |
| Tennessee CVS Pharmacy, L.L.C. | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606694400000",
"number": "1033713169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 E CEDAR ST",
"city": "BRISTOL",
"state": "TN",
"postal_code": "376203928",
"telephone_number": "423-968-7983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 E CEDAR ST",
"city": "BRISTOL",
"state": "TN",
"postal_code": "376203928",
"telephone_number": "423-968-7983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRATER",
"first_name": "RONALD",
"middle_name": "ETHAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-30",
"last_updated": "2020-11-30",
"certification_date": "2020-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "VA",
"license": "0202216140",
"primary": false
},
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "TN",
"license": "41545",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bristol, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.