DR. JASON SCOTT PRUDOM M.D. NPI 1265775993

NPI Information

NPI: 1265775993
Provider Name: DR. JASON SCOTT PRUDOM, M.D.
Classification: Internal Medicine - 207RP1001X
Entity Type: Individual

Specialization: Pulmonary Disease

Organization: GREATER MILWAUKEE CRITICAL CARE AND PULMONARY ASSOCIATES SC

PECOS Registration: Yes

Address:
3201 S 16TH ST STE 2015
MILWAUKEE, WI
ZIP 53215
Phone: (414) 649-3810
Get Directions

DR. Jason Scott Prudom, M.D. is a pulmonary disease internal medicine in Milwaukee, WI with 11 years of experience. The provider is an internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. DR. Jason Scott Prudom, M.D. NPI is 1265775993. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3201 S 16TH ST STE 2015
MILWAUKEE, WI
ZIP 53215-532
Phone: (414) 649-3810
Fax: (262) 240-0841

The NPI 1265775993 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/1/2013 and was last updated on 3/25/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RC0200X	Internal Medicine	Critical Care Medicine	63600-20	WISCONSIN	No
2	207RP1001X	Internal Medicine	Pulmonary Disease	63600-20	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100042547	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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