Kathryn L Prendergast, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50000711 Issued in OH

Practice address

1343 N Fountain Blvd
Springfield, OH 45504-1422

Phone

(937) 390-5000

Fax

(937) 390-5526

NPI assigned

May 16, 2006

Last updated

May 20, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Grady Emergency Physicians Inc.

  • Emergency Medicine Physician
  • Delaware, OH
  • NPI 1477553584
  NPD (past)
• Marysville Emergency Physicians Inc.

  • Emergency Medicine Physician
  • Marysville, OH
  • NPI 1649271594
  NPD (past)
• Observation Medicine Physicians of Champaign County, LTD

  • Emergency Medicine Physician
  • Springfield, OH
  • NPI 1164839726
  NPD (past)
• Spfld Urb Emergency Physicians Inc

  dba Spfld Urb Emergency Physicians Inc/Mercy Urbana

  • Emergency Medicine Physician
  • Urbana, OH
  • NPI 1407858871
  NPD (past)
• Spfld Urb Emergency Physicians Inc

  dba Spfld Urb Emergency Physicians Inc/Mercy Springfield

  • Emergency Medicine Physician
  • Springfield, OH
  • NPI 1679574552
  NPD (past)

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1427000702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4750 HEMPSTEAD STATION DR",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454295164",
            "telephone_number": "800-875-0136",
            "fax_number": "937-619-4231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1343 N FOUNTAIN BLVD",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455041422",
            "telephone_number": "937-390-5000",
            "fax_number": "937-390-5526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENDERGAST",
        "first_name": "KATHRYN",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50000711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00034017",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Prebys, LPCC
• Joseph Premanandan, MD
• Premier Community Health (Premier Health Clinic at Masonic Communities)
• Premier Heart Associates, Inc
• Premiere Chiropractic and Rehab (Springfield Chiropractic)
• Jessica Lynn Priser-Cox, RN
• Privacare LLC
• Project Woman
• Richard Allen Protsman
• Pamela Kay Pulver, L.P.N.

• Physician Assistant in Springfield, OH
• Providers in Springfield, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.