Active NPI
Jorge A Prada, CNS
- Dietary Manager
- Clarkston, MI
National Provider Identifier
1588089684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dietary Manager
- License
- 12017
- Practice address
- 5885 S Main St
Suite 6B
Clarkston, MI 48346-2981 - Phone
- (248) 707-6367
- Fax
- (248) 707-6233
- NPI assigned
- Feb 26, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dietary Manager | 132700000X | 12017 | IL | Primary |
Addresses
Primary practice location
5885 S Main St
Suite 6B
Clarkston, MI 48346-2981
Mailing address
5885 S Main St
Suite 6B
Clarkston, MI 48346-2981
Phone (248) 707-6367
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Specialist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12017 | IL | MD | Dietary Manager |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393372800000",
"number": "1588089684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5885 S MAIN ST",
"address_2": "SUITE 6B",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483462981",
"telephone_number": "248-707-6367",
"fax_number": "248-707-6233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5885 S MAIN ST",
"address_2": "SUITE 6B",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483462981",
"telephone_number": "248-707-6367",
"fax_number": "248-707-6233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRADA",
"first_name": "JORGE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "CNS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-02-26",
"last_updated": "2014-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "132700000X",
"taxonomy_group": "",
"desc": "Dietary Manager",
"state": "IL",
"license": "12017",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.