NPIMap

Individual provider Active NPI

Jose N Prudencio Jr., M.D.

  • Urology Physician
  • Harrisburg, PA
National Provider Identifier
1376590588
Registry record updated Jul 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD035222E Issued in PA
Practice address
815 Sir Thomas CT Ste 200
Harrisburg, PA 17109-4839
Phone
(717) 724-0720
Fax
(717) 724-0730
NPI assigned
May 31, 2006
Last updated
Jul 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD035222E PA Primary

Addresses

Primary practice location

815 Sir Thomas CT Ste 200
Harrisburg, PA 17109-4839

Mailing address

815 Sir Thomas CT Ste 200
Harrisburg, PA 17109-4839
Phone (717) 724-0720

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jprudencio20648@phsdirect.pinnaclehealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051028000141 PA Practitioner - Urology 9032136114 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinnacle Health Medical ServicesGroup PAC ID 7618960493, 1,025 clinicians
Fulton County Medical CenterGroup PAC ID 6406841295, 27 clinicians

Practice addresses (Care Compare)

100 Corporate Ctr Dr
Suite 100
Camp Hill, PA 17011-1758
Phone (717) 724-0380

214 Peach Orchard Rd
MC Connellsburg, PA 17233-8559
Phone 71748531556375

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.08 of 100Reported as group
Quality
76.48
Promoting interoperability
100
Improvement activities
40
Cost
77.12

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Health Medical Services CurrentSince Jul 1, 2021 Accepting new patients
Pinnacle Health Medical Services CurrentSince Jul 1, 2021 Accepting new patients
Fulton County Medical Center CurrentSince Jun 1, 2016 Accepting new patients
Fulton County Medical Center CurrentSince Jun 1, 2016 Accepting new patients
Pinnacle Health Medical Services Current Accepting new patients
Fulton County Medical Center Past Accepting new patients
Pinnacle Health Medical Services Past Accepting new patients

Locations

423 N 21st St
Ste 300
Camp Hill, PA 17011
Phone (717) 763-1174

2501 N 3rd St
Fl 2
Harrisburg, PA 17110
Phone (717) 782-2100

4310 Londonderry Rd
Ste 101
Harrisburg, PA 17109
Phone (717) 724-0720

815 Sir Thomas Ct
Ste 200
Harrisburg, PA 17109
Phone (717) 724-0720

Interoperability endpoints

  • Direct secure messaging: joseprudencio@fcmcpa.medentdirect.com
  • Direct secure messaging: jprudencio20648@phsdirect.pinnaclehealth.org
  • Direct secure messaging: jprudencio538703@upmc.direct-ci.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1376590588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 SIR THOMAS CT STE 200",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171094839",
            "telephone_number": "717-724-0720",
            "fax_number": "717-724-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 SIR THOMAS CT STE 200",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171094839",
            "telephone_number": "717-724-0720",
            "fax_number": "717-724-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDENCIO",
        "first_name": "JOSE",
        "middle_name": "N",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "PA",
            "license": "MD035222E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jprudencio20648@phsdirect.pinnaclehealth.org",
            "affiliation": "N",
            "address_1": "815 Sir Thomas Ct Ste 200",
            "city": "Harrisburg",
            "state": "PA",
            "country_code": "US",
            "postal_code": "171094839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Harrisburg, PA

Sources for this page

Verify at the official NPI Registry.