Individual provider Active NPI

Daryl R Prater, DC

  • Chiropractor
  • Kalamazoo, MI
National Provider Identifier
1629135199
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
23010077517 Issued in MI
Practice address
903 W South St
Kalamazoo, MI 49007
Phone
(269) 343-5021
Fax
(269) 343-5022
NPI assigned
Jan 3, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 23010077517 MI Primary

Addresses

Primary practice location

903 W South St
Kalamazoo, MI 49007

Mailing address

903 W South St
Kalamazoo, MI 49007
Phone (269) 343-5021

Other identifiers 1

IdentifierTypeStateIssuer
4430153OtherIBA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070625000728 MI Practitioner - Chiropractic 8628177151 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1997
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

903 W S St
Kalamazoo, MI 49007-4661
Phone (269) 343-5021

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23010077517MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Prater Chiropractic Wellness Center Inc Chiropractor CurrentSince Jun 1, 2001 Accepting new patients

Locations

903 W South St
Kalamazoo, MI 49007
Phone (269) 343-5021

Organizations & group practices 1

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": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629135199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 W SOUTH ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "49007",
            "telephone_number": "269-343-5021",
            "fax_number": "269-343-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 W SOUTH ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "49007",
            "telephone_number": "269-343-5021",
            "fax_number": "269-343-5022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATER",
        "first_name": "DARYL",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "23010077517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBA",
            "identifier": "4430153",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.