Active NPI
Jessica Rae Pruente, M.D.
- Physical Medicine & Rehabilitation Physician
- Ann Arbor, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 4301114645
- Practice address
- 2205 Commonwealth
Ann Arbor, MI 48105-2945 - Phone
- (734) 936-7175
- NPI assigned
- Jun 27, 2012
- Last updated
- Feb 25, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
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
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.061297 | IL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DLP Marquette Physician Practices Inc | Current | Accepting new patients | |
| Regents of the University of Michigan | Internal Medicine | Current | Accepting new patients |
| Edward W Sparrow Hospital Association | Current | Accepting new patients | |
| DLP Marquette Physician Practices Inc | Current | Accepting new patients | |
| Regents of the University of Michigan | Physical Medicine & Rehabilitation | Current | Accepting new patients |
| Edward W. Sparrow Hospital Association | Current | Accepting new patients | |
| Regents of the University of Michigan | Current | 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
- 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.
-
dba Marquette General Family Medicine - Marquette
- Obesity Medicine (Internal Medicine) Physician
- Marquette, MI
- NPI 1487902995
-
dba Sparrow Regional Children's Center
- Pediatrics Physician
- Lansing, MI
- NPI 1831139088
-
- Internal Medicine Physician
- Ann Arbor, MI
- NPI 1205868353
-
dba UP Health System Pediatric Specialists
- Rural Health Clinic/Center
- Marquette, MI
- NPI 1205635760
-
dba University of Michigan Health-Sparrow
- Adult Health Nurse Practitioner
- Lansing, MI
- NPI 1265220438
-
- Physical Medicine & Rehabilitation Physician
- Ann Arbor, MI
- NPI 1790719532
-
- Specialty Pharmacy
- Dexter, MI
- NPI 1952181919
-
dba University of Michigan Health System
- General Acute Care Hospital
- Ann Arbor, MI
- NPI 1003878539
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba UP Health System Marquette
- General Acute Care Hospital
- Marquette, MI
- NPI 1568727048
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.