Debra Pruyn, LCSW, QMHP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L8013 Issued in OR

Practice address

1644 Carnahan Dr
Grants Pass, OR 97527-4724

Phone

(541) 476-2373

NPI assigned

Jan 24, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR, NY, DE3 enrollments

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 3

Specialty

Clinical Social Worker

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

BMSC Az LLCGroup PAC ID 4385929173, 130 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• BMSC Az LLC

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1497201875

  DE, NY, OR

  Medicare reassignment Care Compare group NPD
• Options for Southern Oregon

  • Mental Illness Community Based Residential Treatment Facility
  • Grants Pass, OR
  • NPI 1083859979
  NPD (past)

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556668800000",
    "number": "1710032081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 SW G ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975262544",
            "telephone_number": "541-476-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1644 CARNAHAN DR",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975274724",
            "telephone_number": "541-476-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUYN",
        "first_name": "DEBRA",
        "name_prefix": "Mrs.",
        "credential": "LCSW, QMHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2019-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "052056-1",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L8013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02074697",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prime Physical Therapy
• Zackeria RL Privett, PSS
• Pro Physical Therapy LLC
• David N Procknow, MD
• Providence Health & Services - Oregon
• Shanna Pugh, PA-C
• Russ Pulliam
• Lance Christopher Pursley, LAC, MAOM
• Regina Purtzer
• Merri Sjaan Pylkas, PT

• Clinical Social Worker in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; 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.
• 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.