NPIMap

Individual provider Active NPI

Duane L Prickett, SA-C, RSA, LSA

  • Surgical Physician Assistant
  • Atlanta, GA
National Provider Identifier
1215084959
Registry record updated Dec 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
1579 Monroe Dr NE Ste F
Atlanta, GA 30324-5022
Phone
(404) 788-1321
NPI assigned
Jan 4, 2007
Last updated
Dec 5, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X GA Primary
Surgical Assistant 246ZC0007X 02-151 GA

Addresses

Primary practice location

1579 Monroe Dr NE Ste F
Atlanta, GA 30324-5022

Mailing address

1579 Monroe Dr NE Ste F
Unit 711
Atlanta, GA 30324-5022
Phone (404) 788-1321

Other identifiers 3

IdentifierTypeStateIssuer
02-151OtherSURGICAL ASSISTANT-CERTIFIED
238.000307OtherILREGISTRATION
SA.0001689OtherCOCOLORADO STATE LICENSE

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
02-151GAMDSurgical Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Atl Colorectal Surgery Current Accepting new patients
Atl Colorectal Surgery Current Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CJAEAA

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386201600000",
    "number": "1215084959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1579 MONROE DR NE STE F",
            "address_2": "UNIT 711",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303245022",
            "telephone_number": "404-788-1321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1579 MONROE DR NE STE F",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303245022",
            "telephone_number": "404-788-1321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRICKETT",
        "first_name": "DUANE",
        "middle_name": "L",
        "credential": "SA-C, RSA, LSA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2013-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": null,
            "primary": true
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "GA",
            "license": "02-151",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SURGICAL ASSISTANT-CERTIFIED",
            "identifier": "02-151",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTRATION",
            "identifier": "238.000307",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO STATE LICENSE",
            "identifier": "SA.0001689",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.

Verify at the official NPI Registry.