David A. Priddy, PHD

Primary specialty

Rehabilitation PsychologistTaxonomy code 103TR0400X

License

071-003839 Issued in IL

Practice address

575 N Kellogg St Ste 4
Galesburg, IL 61401-7609

Phone

(309) 343-0800

Fax

(309) 343-0802

NPI assigned

Jun 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Crossroads Counseling and Life Coaching LLC

  • Professional Counselor
  • Galesburg, IL
  • NPI 1255593315
  Medicare reassignment NPD
• Methodist Medical Center of Illinois

  • Anesthesiology Physician
  • Peoria, IL
  • NPI 1710198379
  NPD (past)

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1669416749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 N KELLOGG ST STE 4",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614017609",
            "telephone_number": "309-343-0800",
            "fax_number": "309-343-0802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 N KELLOGG ST STE 4",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614017609",
            "telephone_number": "309-343-0800",
            "fax_number": "309-343-0802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDDY",
        "first_name": "DAVID",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "IL",
            "license": "071-003839",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE ID",
            "identifier": "013154",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tina M Poliska, ATC
• Allison Elaine Polly, PT, DPT
• Steven G Potaczek, M.D.
• Mark S. Powell, OT
• Premier Anesthesiology LLC
• Whitney Pruett, QMHP
• David W Prygon, CNRA
• Elizabeth J Puthenveetil, M.D.
• Julie A Quam, PA
• Andrea Rose Quinn, LCSW

• Rehabilitation Psychologist in Galesburg, IL
• Providers in Galesburg, IL by specialty
• Rehabilitation Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.