Thomas Jefferson Pridemore Jr., D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038009915 Issued in IL

Practice address

109 S Johnson St
Macomb, IL 61455-2134

Phone

(309) 333-9264

NPI assigned

Oct 21, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Pridemore Chiropractic Center, Inc

  • Chiropractor
  • Macomb, IL
  • NPI 1215010673
  NPD (past) Authorized official

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350259200000",
    "number": "1861575227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 893",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614550893",
            "telephone_number": "309-333-9264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S JOHNSON ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614552134",
            "telephone_number": "309-333-9264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDEMORE",
        "first_name": "THOMAS",
        "middle_name": "JEFFERSON",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-21",
        "last_updated": "2012-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUESHIELD ID",
            "identifier": "05532009",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038009915",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda Powell-Allen, CWNP
• Jodi Powell, ANP
• John Robert Prain, CADC
• Robert William Price III, DMD
• Pridemore Chiropractic Center, Inc
• Joseph William Proctor
• Julissa Rabe
• Andrea Marie Ratermann, RN, IL-CSN
• Darrell Ratermann, RPH
• Larry Dean Rawlins, LCPC

• Chiropractor in Macomb, IL
• Providers in Macomb, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; 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.