Pruchno Medicine LLC. / Health Transitions Clinic

Primary specialty

Renal Nutrition Registered DietitianTaxonomy code 133VN1005X

License

079549 Issued in IA

Legal business name

PRUCHNO MEDICINE LLC. / HEALTH TRANSITIONS CLINIC

Practice address

202 10TH St SE
Cedar Rapids, IA 52403-2414

Phone

(319) 247-3894

NPI assigned

Mar 30, 2017

Organization subpart

No

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

Authorized official

Name

William A. Clayton

Title

Office Manager

Phone

(319) 247-3894

Specialties & licenses 4

Addresses

Other identifiers 1

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

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490832000000",
    "number": "1962934877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 10TH ST SE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524032414",
            "telephone_number": "319-247-3894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 10TH ST SE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524032414",
            "telephone_number": "319-247-3894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUCHNO MEDICINE LLC. / HEALTH TRANSITIONS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-30",
        "last_updated": "2017-03-30",
        "status": "A",
        "authorized_official_last_name": "CLAYTON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "319-247-3894"
    },
    "taxonomies": [
        {
            "code": "132700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietary Manager",
            "state": "IA",
            "license": "079549",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "IA",
            "license": "079549",
            "primary": false
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "IA",
            "license": "079549",
            "primary": true
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "IA",
            "license": "079549",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1101865",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pruchno Medicine, LLC
• Charles Pruchno, MD
• Nicole M Pruchno, ARNP
• Kayla Marie Pruett
• Joshua A Pruitt, M.D.

• All providers in Cedar Rapids, IA
• Renal Nutrition Registered Dietitian in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; 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.