Roger Devern Pruitt, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

L1706 Issued in TX

Practice address

180 Joe Wimberley Blvd
Ste 102
Wimberley, TX 78676-6083

Phone

(512) 847-7700

Fax

(512) 847-7701

NPI assigned

Jun 14, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: roger.pruitt.1@8042.direct.athenahealth.com

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.

• Privia Medical Group Gulf Coast, PLLC

  • Obstetrics & Gynecology Physician
  • Houston, TX
  • NPI 1578969465
  Medicare reassignment NPD
• Privia Medical Group Gulf Coast PLLC

  • Interventional Pain Medicine Physician
  • San Antonio, TX
  • NPI 1457167033
  NPD

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1932104353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 JOE WIMBERLEY BLVD",
            "address_2": "STE 102",
            "city": "WIMBERLEY",
            "state": "TX",
            "postal_code": "786766083",
            "telephone_number": "512-847-7700",
            "fax_number": "512-847-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 JOE WIMBERLEY BLVD",
            "address_2": "STE 102",
            "city": "WIMBERLEY",
            "state": "TX",
            "postal_code": "786766083",
            "telephone_number": "512-847-7700",
            "fax_number": "512-847-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUITT",
        "first_name": "ROGER",
        "middle_name": "DEVERN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "TX",
            "license": "L1706",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L1706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7061167",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0085HZ",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157905401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seth Allen Petross
• Amy Nicole Piatt, LPC-ASSOCIATE
• Matthew Anthony Polhemus, PT
• Nidia A Ponce Orozco, LCSW
• Eric Price, MD
• Alex Ramirez, PT
• Juan Ivan Ramirez, M.D.
• John Ransone, PHD, ATC
• Jacqueline Minard Reddell, LVN
• Resurgence Texas

• Pediatrics Physician in Wimberley, TX
• Providers in Wimberley, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.