Individual provider Active NPI

Jared Prugar

  • Physical Therapist
  • York, ME
National Provider Identifier
1699218107
Registry record updated Dec 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT4789 Issued in ME
Practice address
127 Long Sands Rd
Suite 11
York, ME 03909-1158
Phone
(207) 361-3888
NPI assigned
Dec 1, 2016
Last updated
Dec 1, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT4789 ME Primary

Addresses

Primary practice location

127 Long Sands Rd
Suite 11
York, ME 03909-1158

Mailing address

4 York Shores Dr
York, ME 03909-5371

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PT4789MEMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1480550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480550400000",
    "number": "1699218107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 YORK SHORES DR",
            "city": "YORK",
            "state": "ME",
            "postal_code": "039095371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 LONG SANDS RD",
            "address_2": "SUITE 11",
            "city": "YORK",
            "state": "ME",
            "postal_code": "039091158",
            "telephone_number": "207-361-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUGAR",
        "first_name": "JARED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-01",
        "last_updated": "2016-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT4789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in York, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.