JAY D. PRUETZ (M.D.) – Pediatric Cardiology Physician, NPI 1790771053
Pediatric Cardiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,386 PEDIATRIC MEDICINE in CA
Provider Addresses for JAY D. PRUETZ (M.D.)
Children's Hospital Los Angeles, 4650, West Sunset Boulevard, Los Angeles, Los Angeles County, California, 90029, United States
LOS ANGELES, CA 900276062
Phone: (323) 361-2461
Fax: (323) 361-1513
Type: Mailing
5411 Etiwanda Ave Ste 250
Tarzana, CA 913566158
Phone: (310) 423-1153
Fax: (310) 423-6795
Type: Location
127 S SAN VICENTE BLVD STE A3600
LOS ANGELES, CA 900483311
Phone: (310) 423-1153
Fax: (310) 423-6795
Type: Location
127 S San Vicente Blvd Ste A3600
Los Angeles, CA 900483311
Phone: (310) 423-1153
Fax: (310) 423-6795
Type: Location
4140 W 190TH ST
TORRANCE, CA 905045513
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-10-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20041022001137 | I | Pediatric Medicine | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 90027)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Critical Care (Intensivists), General Surgery | CA | |
| - | WA | |
| Nurse Practitioner | CA | |
| Physician Assistant | CA | |
| Clinical Psychologist | CA | |
| Nurse Practitioner | CA | |
| N E U R O S U R G E R Y | OH | |
| Nurse Practitioner | CA | |
| General Surgery, Critical Care (Intensivists) | CA | |
| Internal Medicine | CA |
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