Lillian Rae Pruitt, LSW
Individual provider Active NPI Social Worker · Medina, OH
NPI 1861006702 · NPPES record last updated Mar 6, 2023
Key facts
- NPI
- 1861006702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- S.2107032 (OH)
- Practice address
- 246 Northland Dr Ste 200a
Medina, OH 44256-3440 - Phone
- (330) 725-9195
- NPI assigned
- Sep 8, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240213003165 | OH | Practitioner - Clinical Social Worker | 4789032301 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.2107032 | OH | MD | Case Management Agency |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alternative Paths, Inc. | Multi-Specialty | Current |
Accepting new patients |
| Alternative Paths Inc. | Multi-Specialty | Current | Accepting new patients |
Locations
246 Northland Dr
Ste 200A
Medina, OH 44256
Phone (330) 725-9195
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Community Health Worker | 172V00000X | OH | ||
| Case Management Agency | 251B00000X | S.2107032 | OH | |
| Social Worker |
104100000X | S.2107032 | OH | Yes |
Addresses
Primary practice location
246 Northland Dr Ste 200a
Medina, OH 44256-3440
Mailing address
246 Northland Dr Ste 200a
Medina, OH 44256-3440
Phone (330) 725-9195
Other practice location 1
3500 Carnegie Ave
Cleveland, OH 44115-2641
Phone (440) 260-8300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0417503 | Medicaid | OH |
Other providers in Medina, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.