Individual provider Active NPI

Jessica Rae Pruente, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Ann Arbor, MI
National Provider Identifier
1619231362
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
4301114645 Issued in MI
Practice address
2205 Commonwealth
Ann Arbor, MI 48105-2945
Phone
(734) 936-7175
NPI assigned
Jun 27, 2012
Last updated
Feb 25, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125.061297 IL
Physical Medicine & Rehabilitation Physician 208100000X 4301114645 MI Primary

Addresses

Primary practice location

2205 Commonwealth
Ann Arbor, MI 48105-2945

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

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
I20180724002204 MI Practitioner - Physical Medicine and Rehabilitation 7416198445 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Michigan State University College of Human Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1414 W Fair Ave
Marquette, MI 49855-2675

850 W Baraga Ave
Marquette, MI 49855-4550

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.061297ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Marquette Physician Practices Inc CurrentSince Apr 1, 2019 Accepting new patients
Regents of the University of Michigan Internal Medicine Current Accepting new patients
Edward W Sparrow Hospital Association CurrentSince Jan 1, 2021 Accepting new patients
DLP Marquette Physician Practices Inc CurrentSince Apr 1, 2019 Accepting new patients
Regents of the University of Michigan Physical Medicine & Rehabilitation CurrentSince Jul 2, 2018 Accepting new patients
Edward W. Sparrow Hospital Association CurrentSince Jan 1, 2021 Accepting new patients
Regents of the University of Michigan CurrentSince Jul 2, 2018 Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

1500 E Medical Center Dr
#D
Ann Arbor, MI 48109
Phone (734) 936-5823

1500 E Medical Center Dr
Fl 3
Ann Arbor, MI 48109
Phone (734) 647-5944

2205 Commonwealth Blvd
Ann Arbor, MI 48105
Phone (734) 615-8475

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

7500 Challis Rd
Brighton, MI 48116
Phone (734) 764-4190

8001 Challis Rd
Brighton, MI 48116
Phone (810) 227-9510

775 S Main St
Chelsea, MI 48118
Phone (313) 995-3764

1200 E Michigan Ave
Ste 460
Lansing, MI 48912
Phone (517) 364-2097

1414 W Fair Ave
Ste 36
Marquette, MI 49855
Phone (906) 225-3864

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

850 W Baraga Ave
Ste 31
Marquette, MI 49855
Phone (906) 449-3600

Interoperability endpoints

  • Direct secure messaging: jessica.pruente.1@8233.direct.athenahealth.com

Organizations & group practices 8

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 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": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1619231362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 COMMONWEALTH",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481052945",
            "telephone_number": "734-936-7175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUENTE",
        "first_name": "JESSICA",
        "middle_name": "RAE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-27",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.061297",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301114645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.