Phillip Andrew Thomas Prusack, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A158786 Issued in CA

Practice address

300 Hillmont Ave
Ventura, CA 93003-1651

Phone

(805) 652-6556

Fax

(805) 652-3252

NPI assigned

Jun 19, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV, FL2 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

Specialty

Family Practice

Education

JC Edwards School of Medicine, Marshall University, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Medicine Services of FL LLCGroup PAC ID 8426413931, 686 clinicians

Paragon Emergency Services LLCGroup PAC ID 8628153087, 401 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Citrus Hospital Hospital, Inverness, FL, CCN 100023
• Tampa General Hospital Crystal River Hospital, Crystal River, FL, CCN 100249

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pprusack326054@ahs.direct-ci.com

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.

• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180
  Medicare reassignment Care Compare group NPD
• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650
  Medicare reassignment Care Compare group NPD
• Hospital Development Co

  dba Roane General Hospital

  • Critical Access Hospital
  • Spencer, WV
  • NPI 1316907322
  Medicare reassignment NPD
• Hospital Development Co

  • Rural Health Clinic/Center
  • Left Hand, WV
  • NPI 1790745677
  Medicare reassignment NPD
• W4P LLC

  dba Hernando County Emergency Physicians

  • Emergency Medicine Physician
  • Spring Hill, FL
  • NPI 1689116618
  Medicare reassignment NPD
• Hospital Development Co

  • Rural Health Clinic/Center
  • Arnoldsburg, WV
  • NPI 1053059881
  NPD
• Hospital Development Co

  • Emergency Medicine Physician
  • Spencer, WV
  • NPI 1184721581

  Family Medicine

  NPD
• Hospital Development Co

  • Ambulance
  • Spencer, WV
  • NPI 1710697040
  NPD
• Hospital Development Co

  • Rural Health Clinic/Center
  • Spencer, WV
  • NPI 1790745172
  NPD (past)

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

• Citrus Memorial Hospital, Inc.

  dba HCA Florida Citrus Hospital

  • General Acute Care Hospital
  • Inverness, FL
  • NPI 1750780342
  Care Compare affiliation
• Tampa General Hospital Citrus LLC

  dba Tampa General Hospital Crystal River

  • General Acute Care Hospital
  • Crystal River, FL
  • NPI 1407637531
  Care Compare affiliation

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

{
    "created_epoch": "1497830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1073043378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S VICTORIA AVE, L4615",
            "address_2": "VCHCA - PHYSICIAN SERVICES",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930090003",
            "telephone_number": "805-677-5181",
            "fax_number": "805-677-5304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HILLMONT AVE",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930031651",
            "telephone_number": "805-652-6556",
            "fax_number": "805-652-3252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUSACK",
        "first_name": "PHILLIP",
        "middle_name": "ANDREW THOMAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-19",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A158786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marina Proektor
• Professional Weight Control Centers
• Progenabiome, LLC
• Flora Estelle Prouse
• Periklis Proussaefs, DDS, MS
• Psychological Behavioral Health Inc
• Ariadna Puchiu
• Brayden Pugh
• Caroline Pulido
• Deepa Pulipati

• Family Medicine Physician in Ventura, CA
• Providers in Ventura, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.