Dr Roger Devern Pruitt, DO is a medicare enrolled "Pediatrics" physician in Wimberley, Texas. His current practice location is
180 Joe Wimberley Blvd, Ste 102, Wimberley, Texas. You can reach out to his office (for appointments etc.) via phone at
(512) 847-7700.
Dr Roger Devern Pruitt is licensed to practice in Texas (license number L1706) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1932104353.
Physician's Profile
| Full Name | Dr Roger Devern Pruitt |
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| Gender | Male |
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| Speciality | Pediatrics |
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| Location | 180 Joe Wimberley Blvd, Wimberley, Texas |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1932104353
- Provider Enumeration Date: 06/14/2005
- Last Update Date: 02/09/2022
Medicare PECOS Information:
- PECOS PAC ID: 0244636041
- Enrollment ID: I20210902000557
Medical Identifiers
Medical identifiers for Dr Roger Devern Pruitt such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1932104353 | NPI | - | NPPES |
| 7061167 | Other | TX | AETNA |
| 0085HZ | Other | TX | BLUE CROSS BLUE SHIELD |
| 157905401 | Medicaid | TX | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 2080A0000X | Pediatrics - Adolescent Medicine | L1706 (Texas) | Secondary |
| 208000000X | Pediatrics | L1706 (Texas) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Roger Devern Pruitt allows following entities to bill medicare on his behalf.
| Entity Name | Privia Medical Group Gulf Coast Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1578969465
PECOS PAC ID: 4688999022
Enrollment ID: O20150206000763 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Roger Devern Pruitt is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Roger Devern Pruitt, DO
180 Joe Wimberley Blvd, Ste 102,
Wimberley, TX 78676-6083
Ph: (512) 847-7700 | Dr Roger Devern Pruitt, DO
180 Joe Wimberley Blvd, Ste 102,
Wimberley, TX 78676-6083
Ph: (512) 847-7700 |
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