Active NPI
Michael Thomas Pruchnicki, M.D.
- Anesthesiology Physician
- West Des Moines, IA
National Provider Identifier
1891773271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 26940
- Practice address
- 4200 University Ave Ste 300
West Des Moines, IA 50266-5945 - Phone
- (515) 401-1950
- Fax
- (515) 401-1955
- NPI assigned
- Jan 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 26940 | IA | Primary |
Addresses
Primary practice location
4200 University Ave Ste 300
West Des Moines, IA 50266-5945
Mailing address
4200 University Ave Ste 300
West Des Moines, IA 50266-5945
Phone (515) 401-1950
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4267 | Other | IA | MIDLANDS PROVIDER # |
| IA0122 | Other | IA | JOHN DEERE PROVIDER # |
| 26940 | Other | IA | TRICARE PROVIDER # |
| 27660 | Other | IA | BLUE SHIELD PROVIDER # |
| 050035373 | Other | IA | RAILROAD MEDICARE # |
| 0058420 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26940 | IA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585612800000",
"number": "1891773271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 UNIVERSITY AVE STE 300",
"city": "WEST DES MOINES",
"state": "IA",
"postal_code": "502665945",
"telephone_number": "515-401-1950",
"fax_number": "515-401-1955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 UNIVERSITY AVE STE 300",
"city": "WEST DES MOINES",
"state": "IA",
"postal_code": "502665945",
"telephone_number": "515-401-1950",
"fax_number": "515-401-1955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUCHNICKI",
"first_name": "MICHAEL",
"middle_name": "THOMAS",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-05",
"last_updated": "2020-03-31",
"certification_date": "2020-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "IA",
"license": "26940",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS PROVIDER #",
"identifier": "4267",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE PROVIDER #",
"identifier": "IA0122",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE PROVIDER #",
"identifier": "26940",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PROVIDER #",
"identifier": "27660",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE #",
"identifier": "050035373",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0058420",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.