Individual provider Active NPI

Edward G Pratt, M.D.

  • Family Medicine Physician
  • Lakeway, TX
National Provider Identifier
1629254461
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
Q6359 Issued in TX
Practice address
1008 Ranch Rd 620 South, Ste 200
Lakeway, TX 78734-5633
Phone
(512) 263-9072
Fax
(512) 402-9057
NPI assigned
Jan 10, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2613 GA
Family Medicine Physician 207Q00000X Q6359 TX Primary

Addresses

Primary practice location

1008 Ranch Rd 620 South, Ste 200
Lakeway, TX 78734-5633

Mailing address

1008 Ranch Rd 620 South, Ste 200
Lakeway, TX 78734-5633
Phone (512) 263-9072

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20151117003072 TX Practitioner - Family Practice 1355580549

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2613GAMDFamily Medicine Physician
Q6359TXMDFamily Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1629254461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 RANCH RD 620 SOUTH, STE 200",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787345633",
            "telephone_number": "512-263-9072",
            "fax_number": "512-402-9057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 RANCH RD 620 SOUTH, STE 200",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787345633",
            "telephone_number": "512-263-9072",
            "fax_number": "512-402-9057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATT",
        "first_name": "EDWARD",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-10",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "2613",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "Q6359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeway, TX

Sources for this page

Verify at the official NPI Registry.