Pro Longevity Seniors LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRO LONGEVITY SENIORS LLC

Doing business as

Pro Longevity Seniors LLC

Practice address

4320 Bridgetown Rd
Cincinnati, OH 45211-4428

Phone

(513) 574-4550

NPI assigned

Jul 23, 2020

Organization subpart

No

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

Authorized official

Name

Ruth Allendoerfer-Fernandez, MDNPI 1013964246

Title

President

Phone

(513) 276-7129

Specialties & licenses 1

Addresses

Other names 1

• Pro Longevity Seniors LLC Doing business as

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.

• Ruth Allendoerfer-Fernandez, M.D.

  • Internal Medicine Physician
  • Cincinnati, OH
  • NPI 1013964246
  Authorized official Same address or phone

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

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595462400000",
    "number": "1215546452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1648 PULLAN AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452232009",
            "telephone_number": "513-276-7129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 BRIDGETOWN RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452114428",
            "telephone_number": "513-574-4550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO LONGEVITY SENIORS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-23",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A",
        "authorized_official_last_name": "ALLENDOERFER-FERNANDEZ",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "513-276-7129",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro Longevity Seniors LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Tara C Proano-Raps, PSY.D
• Diane L. Proctor, RN, CNS
• John Hartman Proctor, MD
• Kristen Proctor, PHARMD.

• Internal Medicine Physician in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; 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.