Active NPI
Haley Nicole Pritz, RD
- Registered Dietitian
- Bloomington, IL
National Provider Identifier
1699485383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.008915
- Practice address
- 3024 E Empire St
Bloomington, IL 61704-5402 - Phone
- (309) 556-7230
- NPI assigned
- Dec 2, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164.008915 | IL | Primary |
Addresses
Primary practice location
3024 E Empire St
Bloomington, IL 61704-5402
Mailing address
1287 Healing Stone CT Apt 10
Normal, IL 61761-9591
Phone (815) 274-4942
Other names 1
- Haley Nicole Pucel
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240130000642 | MO | Practitioner - Registered Dietitian Or Nutrition Professional | 3072966761 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.008915 | IL | MD | Registered Dietitian |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669939200000",
"number": "1699485383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1287 HEALING STONE CT APT 10",
"city": "NORMAL",
"state": "IL",
"postal_code": "617619591",
"telephone_number": "815-274-4942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3024 E EMPIRE ST",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617045402",
"telephone_number": "309-556-7230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRITZ",
"first_name": "HALEY",
"middle_name": "NICOLE",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-02",
"last_updated": "2022-12-02",
"certification_date": "2022-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.008915",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "HALEY",
"last_name": "PUCEL",
"middle_name": "NICOLE",
"credential": "RD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.