Prodigal Primary Care PC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PRODIGAL PRIMARY CARE PC

Practice address

598 John Deere Dr
Maynardville, TN 37807-3212

Phone

(865) 288-3754

Fax

(865) 745-1873

NPI assigned

Jun 21, 2013

Last updated

Nov 1, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. David E Brickhouse, PA

Title

PA

Phone

(865) 288-3754

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gayanne Jean Ballinger, NP

  • Nurse Practitioner
  • Knoxville, TN
  • NPI 1083890040
  NPD (past)
• Michael Anthony Lapaglia Jr., M.D.

  • Emergency Medicine Physician
  • Oak Ridge, TN
  • NPI 1902020548
  NPD (past)
• Dale J Brewer, D.O.

  • Family Medicine Physician
  • Cedar Hill, MO
  • NPI 1952394041
  NPD (past)

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383264000000",
    "number": "1881033959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 ESSARY DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379182468",
            "telephone_number": "865-394-6706",
            "fax_number": "865-394-6719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "598 JOHN DEERE DR",
            "city": "MAYNARDVILLE",
            "state": "TN",
            "postal_code": "378073212",
            "telephone_number": "865-288-3754",
            "fax_number": "865-745-1873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGAL PRIMARY CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-21",
        "last_updated": "2013-11-01",
        "status": "A",
        "authorized_official_last_name": "BRICKHOUSE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PA",
        "authorized_official_telephone_number": "865-288-3754",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Baxter Osborn, D.D.S
• John C. Osborn, D.D.S.
• Karissa Peterson
• Joy M Petree, RN
• Mary Elizabeth Phillips, LMSW
• Deidra Lane Rasnick, RN
• Reliant Family Health, Inc
• Leslie Lashea Rigsby
• Julie M Roberts, PHARMD
• Nathan Robertson, DMD

• Durable Medical Equipment & Medical Supplies in Maynardville, TN
• Providers in Maynardville, TN by specialty
• Durable Medical Equipment & Medical Supplies in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.