Active NPI
Keith Alan Pratt
- Addiction (Substance Use Disorder) Counselor
- San Diego, CA
National Provider Identifier
1104162684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 3340 Kemper St
Suite 105
San Diego, CA 92110-4906 - Phone
- (619) 523-8121
- Fax
- (619) 523-8742
- NPI assigned
- Jan 2, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
3340 Kemper St
Suite 105
San Diego, CA 92110-4906
Mailing address
3340 Kemper St
Suite 105
San Diego, CA 92110-4906
Phone (619) 523-8121
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 373781 | Medicaid | CA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357084800000",
"number": "1104162684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 KEMPER ST",
"address_2": "SUITE 105",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921104906",
"telephone_number": "619-523-8121",
"fax_number": "619-523-8742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3340 KEMPER ST",
"address_2": "SUITE 105",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921104906",
"telephone_number": "619-523-8121",
"fax_number": "619-523-8742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRATT",
"first_name": "KEITH",
"middle_name": "ALAN",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-01-02",
"last_updated": "2013-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "373781",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.