Andre B Pruitt, PH.D., MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3529 Issued in OR

Practice address

1220 SW Morrison St Ste 730
Portland, OR 97205-2226

Phone

(503) 860-1213

Fax

(503) 988-3676

NPI assigned

Jan 17, 2007

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

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Rustic Sage LLC

  • Clinical Social Worker
  • Portland, OR
  • NPI 1861158610
  NPD Authorized official

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1205988532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6926 NE 22ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972115245",
            "telephone_number": "503-860-1213",
            "fax_number": "844-889-4937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 SW MORRISON ST STE 730",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052226",
            "telephone_number": "503-860-1213",
            "fax_number": "503-988-3676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUITT",
        "first_name": "ANDRE",
        "middle_name": "B",
        "credential": "PH.D., MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "3529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan R Prue, LMT
• Amy Kathleen Pruett, DMD
• David Rollins Pruett, M.D.
• Jill Elizabeth Pruett, MD
• Laura Pruett, PHARM.D.
• Joseph David Pruitt
• Genevieve Pruneau, PHD
• Jennifer Carol Prunty, O.D.
• William J Prunty, OD
• Kristina Marie Prus, M.D.

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.