Chase A Pruitt, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7127 Issued in NE

Practice address

5040 S 153Rd St
Omaha, NE 68137-5067

Phone

(402) 881-7996

NPI assigned

Jul 23, 2010

Last updated

Jun 29, 2016By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1279843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467158400000",
    "number": "1245543842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5040 S 153RD ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681375067",
            "telephone_number": "402-881-7996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5040 S 153RD ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681375067",
            "telephone_number": "402-881-7996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUITT",
        "first_name": "CHASE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-23",
        "last_updated": "2016-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NE",
            "license": "7127",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NE",
            "license": "28850",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Provider LLC
• Provision Eye Care LLC
• Jessica Prucha, PHARMD
• William Pruett, MD
• Ashlee Sue Pruis-Trapp, PLMHP
• Christina Leigh Pruitt, D.D.S.
• Melissa Renee Pruitt, MS, LIMHP, LPC
• Tariq Pruitt
• Jessica Elaine Prusa Flores, M.D.
• Kathyrn Prusacki

• Oral and Maxillofacial Surgery (Dentist) in Omaha, NE
• Providers in Omaha, NE by specialty
• Oral and Maxillofacial Surgery (Dentist) in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; 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.