Active NPI
Andrew L Pruitt, P.A.
- Physician Assistant
- Boulder, CO
National Provider Identifier
1194707745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 178
- Practice address
- 311 Mapleton Ave
Boulder, CO 80304-3979 - Phone
- (303) 544-5700
- Fax
- (303) 544-5710
- NPI assigned
- Nov 18, 2005
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 178 | CO | Primary |
Addresses
Primary practice location
311 Mapleton Ave
Boulder, CO 80304-3979
Mailing address
345 Maxwell Ave
Boulder, CO 80304-3972
Phone (303) 544-5783
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07178007 | Medicaid | CO |
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178 | CO | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boulder Community Health | Past | Accepting new patients | |
| Boulder Community Health | 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 and National Provider Directory roles.
-
- Medical Specialty Clinic/Center
- Boulder, CO
- NPI 1407685498
-
- Multi-Specialty Clinic/Center
- Boulder, CO
- NPI 1609822030
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358899200000",
"number": "1194707745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "345 MAXWELL AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803043972",
"telephone_number": "303-544-5783",
"fax_number": "303-441-2388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "311 MAPLETON AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803043979",
"telephone_number": "303-544-5700",
"fax_number": "303-544-5710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUITT",
"first_name": "ANDREW",
"middle_name": "L",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-18",
"last_updated": "2013-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "178",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "07178007",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.