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Individual provider Active NPI

John R Pradko, D.O.

  • Family Medicine Physician
  • Clinton TWP, MI
National Provider Identifier
1619956497
Registry record updated Dec 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
JP010124 Issued in MI
Practice address
33720 Harper Ave
Suite a
Clinton TWP, MI 48035
Phone
(586) 294-5210
Fax
(586) 294-0215
NPI assigned
Jan 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X JP010124 MI Primary

Addresses

Primary practice location

33720 Harper Ave
Suite a
Clinton TWP, MI 48035

Mailing address

33720 Harper Ave
Suite a
Clinton TWP, MI 48035
Phone (586) 294-5210

Other identifiers 1

IdentifierTypeStateIssuer
3223681MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20051109000858 MI Practitioner - Family Practice 8022092618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren MacombGroup PAC ID 8921912791, 131 clinicians

Practice addresses (Care Compare)

33720 Harper Ave
Clinton Township, MI 48035-4255
Phone (586) 294-5210

Hospital & facility affiliations

  • Residential Home Health Home health agency, Troy, MI, CCN 237459
  • McLaren Macomb Hospital, Mount Clemens, MI, CCN 230227
  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089
  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10124MIMDGeneral Practice Dentistry
JP010124MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Macomb Family Medicine CurrentSince Jul 1, 2012 Accepting new patients
Lakeshore Medical Center, P.C. Family Medicine PastSince Jan 1, 2004 Accepting new patients
McLaren Macomb Past Accepting new patients

Locations

33720 Harper Ave
Clinton Twp, MI 48035
Phone (586) 268-2113

33720 Harper Ave
Ste A
Clinton Twp, MI 48035
Phone (586) 294-5210

37399 Garfield Rd
Ste 203
Clinton Twp, MI 48036
Phone (586) 228-2911

37771 Schoenherr Rd
Ste 102
Sterling Hts, MI 48312
Phone (586) 268-2113

Organizations & group practices 3

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

Hospital & facility affiliations 8

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": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197244800000",
    "number": "1619956497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33720 HARPER AVE",
            "address_2": "SUITE A",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "48035",
            "telephone_number": "586-294-5210",
            "fax_number": "586-294-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33720 HARPER AVE",
            "address_2": "SUITE A",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "48035",
            "telephone_number": "586-294-5210",
            "fax_number": "586-294-0215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRADKO",
        "first_name": "JOHN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2007-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "JP010124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3223681",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton TWP, MI

Sources for this page

Verify at the official NPI Registry.