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Physician Compare National (NPI:1700978889)

HEALTHCARE PROVIDER: CHARLES PRUITT M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information

NPI 1700978889
Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID 8729998984
Unique individual clinician ID assigned by PECOS
Professional Enrollment ID I20100928000845
Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name PRUITT
Individual professional last name
Provider First Name CHARLES
Individual professional first name
Provider Gender M
The provider's gender if the provider is a person.

Medical School Information

Medical School Name UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
Individual professional's medical school
Graduation Year 1970
Individual professional's medical school graduation year
Primary Specialty FAMILY MEDICINE
Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information

Line 1 Street Address 360 SIMPSON HWY 149
Group Practice or individual's line 1 address
Line 2 Street Address SUITE 300
Group Practice or individual's line 2 address
City MAGEE
Group Practice or individual's city
State MS
Group Practice or individual's state
Zip Code 391113848
Group Practice or individual's zip code (9 digits when available)
Phone Number 6018491230
Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information

Hospital Affiliation CCN 1 250124
Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1 MAGEE GENERAL HOSPITAL
Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2 251300
Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2 LACKEY MEMORIAL HOSPITAL
Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3 251317
Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3 SIMPSON GENERAL HOSPITAL CAH
Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4 251326
Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4 JEFFERSON DAVIS GENERAL HOSPITAL
Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5 251325
Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5 COVINGTON COUNTY HOSPITAL CAH
Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment Y

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