Theodore C Prentice, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

WG38015M Issued in CA

Practice address

11525 Brookshire Ave Ste 205
Downey, CA 90241-4982

Phone

(562) 861-1988

Fax

(562) 861-5835

NPI assigned

Aug 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

NeurologyAlso: Neuropsychiatry, Psychiatry

Education

State University of New York at Buffalo School of Medicine, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prentice Mitri and HijazinGroup PAC ID 0941254973, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Prentice Mitri & Hijazin

  • Specialist
  • Downey, CA
  • NPI 1881899391
  Medicare reassignment Care Compare group Authorized official
• Memorial Medical Group Inc

  • Durable Medical Equipment & Medical Supplies
  • Phoenix, AZ
  • NPI 1255523643
  NPD (past)

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270598400000",
    "number": "1194733436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11525 BROOKSHIRE AVE STE 205",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902414982",
            "telephone_number": "562-861-1988",
            "fax_number": "562-861-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11525 BROOKSHIRE AVE STE 205",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902414982",
            "telephone_number": "562-861-1988",
            "fax_number": "562-861-5835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENTICE",
        "first_name": "THEODORE",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2010-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "WG38015M",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0066640",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "WG38015M",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Marie Prado
• Pramod Multani MD Inc
• Premier Physical Therapy, Inc.
• Premiere Therapy Services Inc.
• Prentice Mitri & Hijazin
• Joseph Prey, PHARMD
• Prima Vida Medical Clinic, Inc.
• Princess Medical Group Apc
• Princess Obstetrics and Gynecology, Apc
• Dwisha Lanae Pritchett

• Neurology Physician in Downey, CA
• Providers in Downey, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; 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.