Michael George Pruner, ARNP
Individual provider Active NPI Adult Health Nurse Practitioner · Cave Junction, OR
NPI 1356472161 · NPPES record last updated Nov 18, 2015
Key facts
- NPI
- 1356472161
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 201394159NP-PP (OR)
- Practice address
- 25647 Redwood Hwy
Cave Junction, OR 97523-9332 - Phone
- (541) 592-4111
- Fax
- (541) 592-3916
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sky Lakes Medical Center Inc
Practice addresses (Care Compare)
2821 Daggett Ave
Suite 200
Klamath Falls, OR 97601-1130
Phone (541) 274-8400
Hospital & facility affiliations
- Sky Lakes Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141119002511 | OR | Practitioner - Nurse Practitioner | 4789772542 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ARNP 3366972 | FL | MD | Adult Health Nurse Practitioner |
| 201394159NP-PP | OR | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sky Lakes Medical Center Inc | Current |
Accepting new patients | |
| Chuluota Clinic, LLC | Current |
Accepting new patients | |
| Allcare Medical Group LLC | Current |
Accepting new patients | |
| Sky Lakes Medical Center Inc | Current |
Accepting new patients | |
| Northwest Family Practice LLC | Past |
Accepting new patients | |
| Precision Pulmonary NP, Inc. | Past |
Accepting new patients | |
| Lwafp PC Inc | Adult Health | Past | Accepting new patients |
Locations
107 W 8th St
Chuluota, FL 32766
Phone (407) 542-7961
341 E Cottage Park Dr
Ste 1
Cave Junction, OR 97523
Phone (541) 450-3625
1701 NE 7th St
Grants Pass, OR 97526
Phone (541) 471-4106
2865 Daggett Ave
Klamath Falls, OR 97601
Phone (541) 833-6221
2821 Daggett Ave
Ste 200
Klamath Falls, OR 97601
Phone (541) 274-8400
Interoperability endpoints
- michaelpruner@acmgllc.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | ARNP 3366972 | FL | |
| Adult Health Nurse Practitioner | 363LA2200X | 201394159NP-PP | OR | Yes |
Addresses
Primary practice location
25647 Redwood Hwy
Cave Junction, OR 97523-9332
Mailing address
1701 NW Hawthorne Ave
Grants Pass, OR 97526-1257
Phone (541) 592-4111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ARNP 3366972 | Other | FL | ARNP |
| 500676542 | Medicaid | OR |
Other providers in Cave Junction, OR
- Steve Mock
- James D Nordal
- Options for Southern Oregon
- Options for Southern Oregon
- Margaret Philhower
- Alexandra Erin Reed
- Nicole Ann Rensenbrink
- Karin Rohland
- Christine Rotin
- Jocelyn Lee Rousseau
All providers in Cave Junction, OR · Adult Health Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.