Ryan Sanford Prudoff, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

R5027 Issued in TX

Practice address

1210 W University Ave
Georgetown, TX 78628-5333

Phone

(216) 513-2236

NPI assigned

Jun 6, 2007

Last updated

Nov 26, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH, TX2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brushy Creek Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Round Rock, TX
  • NPI 1235773151
  Medicare reassignment NPD
• Lake Travis Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Austin, TX
  • NPI 1851803688
  Medicare reassignment NPD
• Emergency Professional Services, Inc.

  dba Emergency Professional Services of Ohio, Inc.

  • Emergency Medicine Physician
  • Seaman, OH
  • NPI 1093762353
  Medicare reassignment NPD
• Emergency Care Specialists Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Garfield Heights, OH
  • NPI 1164461026
  NPD (past)
• General Emergency Medical Specialists, Inc.

  dba Gems

  • Emergency Medicine Physician
  • Akron, OH
  • NPI 1821055856
  NPD (past)
• Memorial Hospital

  • General Acute Care Hospital
  • Fremont, OH
  • NPI 1851338149
  NPD (past)
• MMS Emergency Physicians Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Broadview Heights, OH
  • NPI 1982643755
  NPD (past)

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1740483122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 W UNIVERSITY AVE",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786285333",
            "telephone_number": "216-513-2236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 W UNIVERSITY AVE",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786285333",
            "telephone_number": "216-513-2236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 E Market St",
            "address_purpose": "LOCATION",
            "city": "Akron",
            "state": "OH",
            "postal_code": "443041619",
            "country_code": "US",
            "telephone_number": "330-375-3361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRUDOFF",
        "first_name": "RYAN",
        "middle_name": "SANFORD",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-06",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "R5027",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34.008507",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Primal Shift Physical Therapy LLC
• Primary Foot Care
• Prime Services and Solutions LLC
• Angela Marie Procalamos, LCSW
• Prolab Incorporated (Pro-Lab Diagnostics)
• Psych Dimensions Inc
• Rosana Cecilia Puentes Medina
• Johanna Puetz, L.A.T.
• Sharon L. Pulattie, LMFT, LCDC
• Sabrina Queen, ATC, LAT

• Emergency Medicine Physician in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; 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.