NPIMap

Individual provider Active NPI

Sandra J Prytula

  • Audiologist-Hearing Aid Fitter
  • Saint Clair Shores, MI
National Provider Identifier
1760570576
Registry record updated Dec 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Audiologist-Hearing Aid FitterTaxonomy code 237600000X
License
1601000065 Issued in MI
Practice address
21000 E 12 Mile Rd
Suite 111
Saint Clair Shores, MI 48081-1116
Phone
(586) 779-7610
NPI assigned
Oct 10, 2006
Last updated
Dec 23, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist-Hearing Aid Fitter 237600000X 1601000065 MI Primary

Addresses

Primary practice location

21000 E 12 Mile Rd
Suite 111
Saint Clair Shores, MI 48081-1116

Mailing address

21000 E 12 Mile Rd
Ste 111
St Clair Shores, MI 48081
Phone (586) 779-7610

Other identifiers 4

IdentifierTypeStateIssuer
0E06192OtherMIBLUE SHIELD
0E01107OtherBLUE SHIELD
540E00292OtherMIBLUE SHIELD
640E07684OtherMIBLUE SHIELD

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Ear Nose and Throat Center PC Past Accepting new patients
Professional Hearing Aid Center Audiologist-Hearing Aid Fitter Past Accepting new patients
Oakland Hearing PastSince Aug 8, 1994 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229990400000",
    "number": "1760570576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21000 E 12 MILE RD",
            "address_2": "STE 111",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "48081",
            "telephone_number": "586-779-7610",
            "fax_number": "586-445-2526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21000 E 12 MILE RD",
            "address_2": "SUITE 111",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811116",
            "telephone_number": "586-779-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRYTULA",
        "first_name": "SANDRA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2008-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "MI",
            "license": "1601000065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0E06192",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0E01107",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "540E00292",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "640E07684",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2008; 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.