Jason Scott Prudom, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

63600-20 Issued in WI

Practice address

3201 S 16TH St Ste 2015
Milwaukee, WI 53215-4532

Phone

(414) 649-3810

Fax

(262) 240-0841

NPI assigned

Apr 1, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

Pulmonary DiseaseAlso: Critical Care (Intensivists)

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Midwest Critical Care SCGroup PAC ID 4486026804, 49 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Columbia St Marys Hospital Milwaukee Hospital, Milwaukee, WI, CCN 520051
• Ascension SE Wisconsin Hospital Hospital, Milwaukee, WI, CCN 520136
• Ascension All Saints Hospital Hospital, Racine, WI, CCN 520096
• Ascension St Francis Hospital Hospital, Milwaukee, WI, CCN 520078

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Midwest Critical Care SC

  • Critical Care Medicine (Internal Medicine) Physician
  • Mount Pleasant, WI
  • NPI 1093425647
  Medicare reassignment Care Compare group NPD
• Ascension Medical Group-Southeast Wisconsin Inc

  • Internal Medicine Physician
  • Glendale, WI
  • NPI 1609881077
  Medicare reassignment NPD
• Greater Milwaukee Critical Care and Pulmonary Associates SC

  • Critical Care Medicine (Internal Medicine) Physician
  • Milwaukee, WI
  • NPI 1952569816
  Medicare reassignment NPD
• Prohealth Medical Group Inc.

  • Pediatrics Physician
  • Waukesha, WI
  • NPI 1356322440
  Medicare reassignment NPD
• Prohealth Medical Group Inc

  • Family Medicine Physician
  • Hartland, WI
  • NPI 1386785178
  NPD
• Prohealth Medical Group Inc

  • Family Medicine Physician
  • Waukesha, WI
  • NPI 1790720613
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ascension All Saints Hospital, Inc

  • General Acute Care Hospital
  • Racine, WI
  • NPI 1639123284
  Care Compare affiliation
• Ascension SE Wisconsin Hospital, Inc

  • General Acute Care Hospital
  • Milwaukee, WI
  • NPI 1427007384
  Care Compare affiliation
• Ascension SE Wisconsin Hospital, Inc

  • Rehabilitation Hospital Unit
  • Brookfield, WI
  • NPI 1861417362
  Care Compare affiliation
• Ascension St Francis Hospital, Inc

  • General Acute Care Hospital
  • Milwaukee, WI
  • NPI 1225087190
  Care Compare affiliation
• Columbia St. Mary'S Hospital Milwaukee, Inc.

  • General Acute Care Hospital
  • Milwaukee, WI
  • NPI 1871656082
  Care Compare affiliation

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1265775993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "GREATER MILWAUKEE CRITICAL CARE AND PULMONARY ASSOCIATE",
            "address_2": "PO BOX 070520",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532070520",
            "telephone_number": "414-649-3810",
            "fax_number": "262-240-0841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 S 16TH ST STE 2015",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532154532",
            "telephone_number": "414-649-3810",
            "fax_number": "262-240-0841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDOM",
        "first_name": "JASON",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-01",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WI",
            "license": "63600-20",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WI",
            "license": "63600-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100042547",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Prostek, PHARMD
• Protecter of Many LLC
• Barbara J. Provo, APNP
• Prudent Diagnostics Laboratories
• William F Prudlow, MD
• Paul Pruessing, PA
• Julie Pruett, NP
• Jilliann Nelessen Pruetting, PT
• Ernest Pruitt, BA,SAC-IT
• Marion Eugene Pruitt, MD

• Pulmonary Disease Physician in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Pulmonary Disease Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.