NPIMap

Organization Active NPI

Pruchno Medicine, LLC

  • Internal Medicine Physician
  • Cedar Rapids, IA
National Provider Identifier
1225433675
Registry record updated Oct 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
27892 Issued in IA
Legal business name
PRUCHNO MEDICINE, LLC
Practice address
202 10TH St SE
Suite 200
Cedar Rapids, IA 52403-2414
Phone
(319) 247-3899
NPI assigned
Oct 28, 2014
Last updated
Oct 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2014

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

Authorized official

Name
Charles J Pruchno, M.D.NPI 1194762849
Title
Owner / Provider
Phone
(319) 247-3899

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 27892 IA Primary

Addresses

Primary practice location

202 10TH St SE
Suite 200
Cedar Rapids, IA 52403-2414

Mailing address

PO Box 1112
Cedar Rapids, IA 52406-1112
Phone (319) 247-3899

Other identifiers 1

IdentifierTypeStateIssuer
1101865MedicaidIA

National Provider Directory

National Provider Directory

Locations

202 10th St SE
Ste 200
Cedar Rapids, IA 52403
Phone (319) 247-3899

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414454400000",
    "number": "1225433675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1112",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524061112",
            "telephone_number": "319-247-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 10TH ST SE",
            "address_2": "SUITE 200",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524032414",
            "telephone_number": "319-247-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUCHNO MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2014-10-28",
        "status": "A",
        "authorized_official_last_name": "PRUCHNO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER / PROVIDER",
        "authorized_official_telephone_number": "319-247-3899",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "27892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1101865",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; 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.