Individual provider Active NPI

David Paul Prough, MD

  • Surgery Physician
  • Jackson, MI
National Provider Identifier
1366465528
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301407188 Issued in MI
Practice address
1100 E Michigan Ave
Suite 300
Jackson, MI 49201
Phone
(517) 782-5857
Fax
(517) 784-3237
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301407188 MI Primary

Addresses

Primary practice location

1100 E Michigan Ave
Suite 300
Jackson, MI 49201

Mailing address

1100 E Michigan Ave
Suite 300
Jackson, MI 49201
Phone (517) 782-5857

Other identifiers 1

IdentifierTypeStateIssuer
102754330MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20040218000880 MI Practitioner - General Surgery 3577458595 Reassigns benefits to 1 organization
Practice locations: Jackson, MI

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Wayne State University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
W. a. Foote Memorial Hospital, Inc.Group PAC ID 0244136067, 476 clinicians

Practice addresses (Care Compare)

205 N E Ave
Jackson, MI 49201-1753
Phone (517) 205-4800

Hospital & facility affiliations

  • Henry Ford Allegiance Health Hospital, Jackson, MI, CCN 230092

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)15
Mastectomy1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
W. a. Foote Memorial Hospital, Inc Current Accepting new patients
W.a. Foote Memorial Hospital, Inc Surgery CurrentSince Mar 10, 2020 Accepting new patients
W.a. Foote Memorial Hospital, Inc CurrentSince Mar 10, 2020 Accepting new patients
Wa Foote Memorial Hospital, Inc Past Accepting new patients

Locations

1100 E Michigan Ave
Ste 300
Jackson, MI 49201
Phone (517) 782-5857

1100 E Michigan Ave
Jackson, MI 49201
Phone (517) 205-7605

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

1100 E Michigan Ave
Ste 209
Jackson, MI 49201
Phone (517) 205-8346

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

Interoperability endpoints

  • Direct secure messaging: dprough462683@direct.hfhs.org

Organizations & group practices 4

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 1

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212969600000",
    "number": "1366465528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E MICHIGAN AVE",
            "address_2": "SUITE 300",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49201",
            "telephone_number": "517-782-5857",
            "fax_number": "517-784-3237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E MICHIGAN AVE",
            "address_2": "SUITE 300",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49201",
            "telephone_number": "517-782-5857",
            "fax_number": "517-784-3237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROUGH",
        "first_name": "DAVID",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2008-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301407188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102754330",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.