Donald Graham Prouty, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301041429 Issued in MI

Practice address

820 N Pine River St
Ithaca, MI 48847

Phone

(989) 875-3722

Fax

(989) 875-3732

NPI assigned

Jun 7, 2006

Last updated

Dec 15, 2022By the provider in NPPES

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 5

Medicare fee-for-service enrollment

Enrolled in MI

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

Family Practice

Education

Loma Linda University School of Medicine, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mymichigan Medical Center AlmaGroup PAC ID 3375451404, 140 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mymichigan Medical Center Alma Hospital, Alma, MI, CCN 230030
• Mymichigan Medical Center Clare Hospital, Clare, MI, CCN 230180

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dprouty6855@mymichiganhealth.midirect.net

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michelle Nelson, MD

  • Family Medicine Physician
  • Alma, MI
  • NPI 1215465687
  Medicare reassignment

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mymichigan Medical Center Alma

  • Emergency Medicine Physician
  • Alma, MI
  • NPI 1568914422
  Medicare reassignment Care Compare group NPD
• Donald G Prouty

  dba Ithaca Family Practice

  • Family Medicine Physician
  • Ithaca, MI
  • NPI 1164012019
  NPD Authorized official
• Donald G Prouty

  dba Ithaca Family Practice

  • Family Medicine Physician
  • Ithaca, MI
  • NPI 1164309175
  NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mymichigan Medical Center Alma

  • General Acute Care Hospital
  • Alma, MI
  • NPI 1023097771
  Care Compare affiliation
• Mymichigan Medical Center Clare

  • General Acute Care Hospital
  • Clare, MI
  • NPI 1568414589
  Care Compare affiliation
• Mymichigan Medical Center Midland

  • General Acute Care Hospital
  • Midland, MI
  • NPI 1902841414
  Care Compare affiliation

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1194765198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 N PINE RIVER ST",
            "city": "ITHACA",
            "state": "MI",
            "postal_code": "48847",
            "telephone_number": "989-875-3722",
            "fax_number": "989-875-3732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 N PINE RIVER ST",
            "city": "ITHACA",
            "state": "MI",
            "postal_code": "48847",
            "telephone_number": "989-875-3722",
            "fax_number": "989-875-3732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROUTY",
        "first_name": "DONALD",
        "middle_name": "GRAHAM",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301041429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0802900501",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPLUS COMMERCIAL",
            "identifier": "0983153",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN",
            "identifier": "1009879",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP COMMERCIAL",
            "identifier": "200000005847",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4563131-10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nilay K Parikh
• Cora J Pavlik, FNP
• Tiantaya Perry
• Stephanie Persyn
• Pine River Dental Care
• Putman Dental PLLC (Pine River Dental Care)
• Brian Joseph Putman, D.D.S.
• Jenna Putman
• Rite Aid of Michigan Inc (Rite Aid Pharmacy 01772)
• Rosewood I & Rosewood II

• Family Medicine Physician in Ithaca, MI
• Providers in Ithaca, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; 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.