Derek P Pruni, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

7918 Issued in AZ

Practice address

5233 E Southern Ave
Ste 104
Mesa, AZ 85206-3628

Phone

(480) 785-4959

Fax

(480) 785-4827

NPI assigned

Nov 21, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

East Southern Medical Group LLCGroup PAC ID 0547503542, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

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.

• East Southern Medical Group, LLC

  • Physical Medicine & Rehabilitation Physician
  • Mesa, AZ
  • NPI 1477011237
  Medicare reassignment Care Compare group NPD Authorized official
• Shea Pain Professionals LLC

  • Interventional Pain Medicine Physician
  • Gilbert, AZ
  • NPI 1073247508
  NPD (past)

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492387200000",
    "number": "1154304590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5233 E SOUTHERN AVE",
            "address_2": "SUITE 104",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063625",
            "telephone_number": "480-830-2882",
            "fax_number": "480-830-2881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5233 E SOUTHERN AVE",
            "address_2": "STE 104",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063628",
            "telephone_number": "480-785-4959",
            "fax_number": "480-785-4827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUNI",
        "first_name": "DEREK",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2017-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "7918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9222584",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prosano Health Solutions, Inc.
• Mia Provenzano
• Provider Provider PC
• Stanley Jamar Pruitt
• Trent Pruitt
• Charles H Pshaenich, MD
• Psychology Practice of Judith Rand PHD PLC
• Psychotherapy Associates of Arizona, Inc.
• PTL Behavioral Health, LLC
• Pueblo Pediatrics LTD

• Chiropractor in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.