Individual provider Active NPI

Mary Susan Pruzinsky, MD

  • Otolaryngology/Facial Plastic Surgery Physician
  • Waterloo, IA
National Provider Identifier
1326097296
Registry record updated Feb 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
30009 Issued in IA
Practice address
2710 Saint Francis Dr
Ste 411
Waterloo, IA 50702-5619
Phone
(319) 272-5000
Fax
(319) 272-5825
NPI assigned
May 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 30009 IA Primary

Addresses

Primary practice location

2710 Saint Francis Dr
Ste 411
Waterloo, IA 50702-5619

Mailing address

2710 Saint Francis Dr
Ste 411
Waterloo, IA 50702-5619
Phone (319) 272-5000

Other identifiers 1

IdentifierTypeStateIssuer
56464OtherIABLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20100201000147 IA Practitioner - Otolaryngology 3274676150 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Georgetown University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Center IncGroup PAC ID 0244148732, 234 clinicians

Practice addresses (Care Compare)

226 Bluebell Rd
Cedar Falls, IA 50613-6328
Phone (319) 575-5800

2710 Saint Francis Dr
Waterloo, IA 50702-5619
Phone (319) 272-5000

2710 Saint Francis Dr
Waterloo, IA 50702-5634
Phone (319) 272-5000

3421 W 9TH St
Waterloo, IA 50702-5401

Hospital & facility affiliations

  • Mercyone Waterloo Medical Center Hospital, Waterloo, IA, CCN 160067
  • Sartori Memorial Hospital, Inc Hospital, Cedar Falls, IA, CCN 160040

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
30009IAMDOtolaryngology/Facial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Center Inc CurrentSince Jan 11, 2016 Accepting new patients
Covenant Medical Center, Inc. CurrentSince Jan 11, 2016 Accepting new patients

Locations

751 Main St
Arlington, IA 50606
Phone (563) 633-6965

226 Bluebell Rd
Cedar Falls, IA 50613
Phone (319) 575-5800

3421 W 9th St
Waterloo, IA 50702
Phone (319) 272-7050

2710 Saint Francis Dr
Ste 411
Waterloo, IA 50702
Phone (319) 272-5805

Interoperability endpoints

  • Direct secure messaging: mpruzinsky3935498@direct.trinity-health.org

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454371200000",
    "number": "1326097296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 SAINT FRANCIS DR",
            "address_2": "STE 411",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025619",
            "telephone_number": "319-272-5000",
            "fax_number": "319-272-5825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 SAINT FRANCIS DR",
            "address_2": "STE 411",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025619",
            "telephone_number": "319-272-5000",
            "fax_number": "319-272-5825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUZINSKY",
        "first_name": "MARY SUSAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-09",
        "last_updated": "2016-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "IA",
            "license": "30009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "56464",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.