Active NPI
Richard Brian Prater, PA
- Physician Assistant
- Kennesaw, GA
National Provider Identifier
1841462538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 005499
- Practice address
- 270 Chastain Rd NW
Kennesaw, GA 30144-3012 - Phone
- (770) 421-8005
- Fax
- (770) 424-5662
- NPI assigned
- Apr 2, 2008
- Last updated
- Feb 9, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 005499 | GA | Primary |
Addresses
Primary practice location
270 Chastain Rd NW
Kennesaw, GA 30144-3012
Mailing address
270 Chastain Rd NW
Kennesaw, GA 30144-3012
Phone (770) 421-8005
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 442741884B | Medicaid | GA | |
| 442741884A | Medicaid | GA |
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005499 | GA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakelands Orthopaedic Clinic | Past | Accepting new patients | |
| Resurgens, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
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- Abbeville, SC
- NPI 1154594786
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234137600000",
"number": "1841462538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "270 CHASTAIN RD NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301443012",
"telephone_number": "770-421-8005",
"fax_number": "770-424-5662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "270 CHASTAIN RD NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301443012",
"telephone_number": "770-421-8005",
"fax_number": "770-424-5662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRATER",
"first_name": "RICHARD",
"middle_name": "BRIAN",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-02",
"last_updated": "2009-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "005499",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "442741884B",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "442741884A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.