Premier Medical Group, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

PREMIER MEDICAL GROUP, LLC

Practice address

409 W 1St St
Bloomington, IN 47403-2403

Phone

(561) 556-3721

NPI assigned

Oct 31, 2024

Organization subpart

No

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

Authorized official

Name

Kirill Vesselov

Title

Manager

Phone

(561) 556-3721

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1730332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1104649946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 10TH AVE N",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334613000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 W 1ST ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032403",
            "telephone_number": "561-556-3721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-31",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "VESSELOV",
        "authorized_official_first_name": "KIRILL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "561-556-3721"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ramesh Prajapati, MD
• Dyveke Patrice Pratt, MD
• Premier Healthcare LLC
• Premier Healthcare, LLC
• Premier Healthcare, LLC
• Ryan Wayne Pribble
• Kathleen P Price, NP
• Kayla Price, MS, CCC-SLP
• Jonah Harrison Prickel
• Primary Medicine Associates, LLC

• Substance Use Disorder Rehabilitation Clinic/Center in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; 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.