Donald Paul Prentiss Jr., M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036-096029 Issued in IL

Practice address

1221 N Highland Ave
Aurora, IL 60506-1404

Phone

(630) 859-8700

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in TX, IL, GA, IN, MI, MS6 enrollments

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 6

Specialty

General Surgery

Education

Loyola University of Chicago, Stritch School of Medicine, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Acute Care Surgery Medical Group IncGroup PAC ID 7214006816, 205 clinicians

Porter Physician Services LLCGroup PAC ID 1850482407, 96 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: donald.prentiss@hca5.eclinicaldirectplus.com
• Direct secure messaging: dprentiss128460@direct-ehr-ssmhc.com

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.

• Physician Services Corporation of Southern Illinois Inc.

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807

  Surgery

  Medicare reassignment Care Compare group NPD
• Acute Care Surgery Medical Group, Inc.

  • Surgery Physician
  • Sacramento, CA
  • NPI 1700069549

  MI

  Medicare reassignment Care Compare group NPD
• Porter Physician Services LLC

  • Family Medicine Physician
  • Valparaiso, IN
  • NPI 1508075680
  Medicare reassignment Care Compare group NPD
• Freeport Regional Health Care Foundation

  • Family Medicine Physician
  • Freeport, IL
  • NPI 1457337016

  Surgery

  Medicare reassignment NPD
• Southern Illinois Medical Services, NFP

  • Internal Medicine Physician
  • Carbondale, IL
  • NPI 1770656837
  Medicare reassignment NPD
• St. Mary'S Hospital, Centralia, Illinois

  • Emergency Medicine Physician
  • Centralia, IL
  • NPI 1770687196
  Medicare reassignment NPD
• LHP Texas MD Services, Inc

  • General Practice Physician
  • Harker Heights, TX
  • NPI 1841562667
  Medicare reassignment NPD
• Mayo Clinic Health System in Waycross, Inc.

  • Multi-Specialty Clinic/Center
  • Waycross, GA
  • NPI 1154745982
  Medicare reassignment NPD
• Memorial Satilla Specialists, LLC

  • General Practice Physician
  • Waycross, GA
  • NPI 1295266955
  Medicare reassignment NPD
• Piedmont Athens Hospitalist Physicians LLC

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1578079000
  Medicare reassignment NPD
• Vicksburg Healthcare LLC

  • Anesthesiology Physician
  • Vicksburg, MS
  • NPI 1629084058
  Medicare reassignment NPD
• Good Samaritan Regional Health Center

  • Emergency Medicine Physician
  • Mount Vernon, IL
  • NPI 1487758801
  Medicare reassignment

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

• Good Samaritan Regional Health Center

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1609897339
  Care Compare affiliation

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1275617839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1870 W GALENA BLVD",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605064356",
            "telephone_number": "630-859-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 N HIGHLAND AVE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605061404",
            "telephone_number": "630-859-8700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 W Jackson St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011474",
            "country_code": "US",
            "telephone_number": "618-457-3006",
            "fax_number": "618-457-3008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRENTISS",
        "first_name": "DONALD",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01074235A",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "K8818",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036-096029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036096029",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "K8818",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "01074235A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS#",
            "identifier": "04515143",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "7258113",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "0072GK",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Aurora, IL
• Providers in Aurora, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; 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.