Prudy Medical

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRUDY MEDICAL

Practice address

6718 144TH St NW
Gig Harbor, WA 98332-8738

Phone

(253) 857-6166

NPI assigned

Aug 28, 2024

Last updated

Oct 21, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Corrine Gallagher

Title

Owner

Phone

(253) 857-6166

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephanie Lynne Shah

  • Medical Physician Assistant
  • Gig Harbor, WA
  • NPI 1639666118
  Medicare reassignment Care Compare group NPD
• Michael Dan Wingren, MD

  • Family Medicine Physician
  • University Place, WA
  • NPI 1760595664
  Medicare reassignment Care Compare group NPD
• Julia Elizabeth Cathcart-Chang

  • Medical Physician Assistant
  • Lakewood, WA
  • NPI 1174831440
  Medicare reassignment Care Compare group
• Paula Ann Constance, ARNP

  • Nurse Practitioner
  • Tacoma, WA
  • NPI 1437175676
  Medicare reassignment Care Compare group
• Brandon Scott Weaver, PA-C

  • Medical Physician Assistant
  • Federal Way, WA
  • NPI 1053632083
  Medicare reassignment

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

{
    "created_epoch": "1724803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1790519015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6718 144TH ST NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983328738",
            "telephone_number": "253-857-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6718 144TH ST NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983328738",
            "telephone_number": "253-857-6166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUDY MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-28",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "GALLAGHER",
        "authorized_official_first_name": "CORRINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-857-6166"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Janeen Provazek, MA
• Benjamin Pruden, DC
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• Family Medicine Physician in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.