Pride Medical Spa and Wellness Center Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRIDE MEDICAL SPA AND WELLNESS CENTER INC

Practice address

6380 Mae Anne Ave
Unit 7
Reno, NV 89523-4712

Phone

(775) 432-1500

Fax

(775) 432-1002

NPI assigned

Oct 30, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Greg Jones, CRNA

Title

Clinic Administrator

Phone

(775) 432-1500

Specialties & licenses 1

Addresses

Other names 1

• Radiance Ketamine Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in NV

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

Tax ID family

Pride Medical Spa and Wellness Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pride Medical Spa and Wellness Center Inc

  • Psychiatry Physician
  • Reno, NV
  • NPI 1912543968
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Francisco L Dofeliz, M.D.

  • Family Medicine Physician
  • Reno, NV
  • NPI 1891043832
  Medicare reassignment Care Compare group NPD
• Emmanuelle Garcia-Rider, MD

  • Psychiatry Physician
  • Reno, NV
  • NPI 1407359250
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1572393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1861036063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6380 MAE ANNE AVE",
            "address_2": "UNIT 7",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895234712",
            "telephone_number": "775-432-1500",
            "fax_number": "775-432-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6380 MAE ANNE AVE",
            "address_2": "UNIT 7",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895234712",
            "telephone_number": "775-432-1500",
            "fax_number": "775-432-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIDE MEDICAL SPA AND WELLNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-30",
        "last_updated": "2024-04-24",
        "certification_date": "2019-12-17",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "775-432-1500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Radiance Ketamine Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Radiance Ketamine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maryann Elizabeth Price, RN
• Peggy Price
• Shawn Cornell Price
• Tira Price, LMSW, CSWI
• Pride House
• Pride Medical Spa and Wellness Center Inc
• Sarah Pridham, PT/DPT
• Richard Priest, M.D.
• Heidi Anna Priestley, LGSW
• Bethany Prieto

• Family Medicine Physician in Reno, NV
• Providers in Reno, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.