Samuel J Pruden II, MD

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

34192 Issued in KY

Practice address

989 Governors LN Ste 260
Lexington, KY 40513-1175

Phone

(859) 296-7546

Fax

(859) 721-0829

NPI assigned

Jul 29, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

DermatologyAlso: Pathology, Plastic and Reconstructive Surgery

Education

University of Louisville School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Regional Dermatology PLLC

  dba Skin MD

  • MOHS-Micrographic Surgery Physician
  • Lexington, KY
  • NPI 1255851200
  Medicare reassignment NPD Authorized official
• Kentucky Medical Services Foundation, Inc

  • Internal Medicine Physician
  • Lexington, KY
  • NPI 1326091448
  Medicare reassignment NPD
• Facial Plastic Surgery & Dermatology PLLC

  • MOHS-Micrographic Surgery Physician
  • Lexington, KY
  • NPI 1881030088
  NPD (past) Authorized official
• Heartland ENT & Allergy Center, P.S.C.

  • Otolaryngology Physician
  • Elizabethtown, KY
  • NPI 1780763078
  NPD (past)

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1871593996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "989 GOVERNORS LN STE 220",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405131175",
            "telephone_number": "859-296-7546",
            "fax_number": "859-721-0829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "989 GOVERNORS LN STE 260",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405131175",
            "telephone_number": "859-296-7546",
            "fax_number": "859-721-0829"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "448 Lewis Hargett Cir",
            "address_2": "STE. 240",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405033594",
            "country_code": "US",
            "telephone_number": "859-226-0206",
            "fax_number": "859-226-0207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRUDEN",
        "first_name": "SAMUEL",
        "middle_name": "J",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "KY",
            "license": "34192",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "KY",
            "license": "34192",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "KY",
            "license": "34192",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "KY",
            "license": "34192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000823142",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64051196",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ian Lee Provancha, MD
• Providence Medical LLC
• Janalyn Prows, M.D.
• Jinger Renee Pruden, M.A., CCC-A
• Robert James Pruden, PT
• Brandon Pruitt, MD
• Hope Elizabeth Pruitt, LCSW
• Kimberly Dawn Pruitt, APRN
• Madison K Pruitt, DO
• Sarah Elizabeth Pruitt, DO

• MOHS-Micrographic Surgery Physician in Lexington, KY
• Providers in Lexington, KY by specialty
• MOHS-Micrographic Surgery Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.