SAMUEL J II PRUDEN (MD) – MOHS-Micrographic Surgery Physician, NPI 1871593996
MOHS-Micrographic Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
228 PATHOLOGY in KY
Provider Addresses for SAMUEL J II PRUDEN (MD)
989 GOVERNORS LN STE 220
LEXINGTON, KY 405131175
Phone: (859) 296-7546
Fax: (859) 721-0829
Type: Location
448 Lewis Hargett Cir
STE. 240
Lexington, KY 405033594
Phone: (859) 226-0206
Fax: (859) 226-0207
Type: Location
989 GOVERNORS LN STE 260
LEXINGTON, KY 405131175
Phone: (859) 296-7546
Fax: (859) 721-0829
Type: Location
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.
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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: 2004-03-23
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 |
|---|---|---|---|---|
| I20040323000851 | I | Dermatology | KY | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| J7345 | Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg | 5,100 | 24 | $0 |
| 17003 | Destruction of precancer skin growth, 2-14 growths | 439 | 63 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 164 | 106 | $0 |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 155 | 86 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 115 | 78 | $0 |
Insurance plans in this area (ZIP 40513)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DERMATOLOGY | KY | 13132 | Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet | 12 | 11 |
| DERMATOLOGY | KY | 17003 | Destruction of 2-14 skin growths | 342 | 93 |
| DERMATOLOGY | KY | 88312 | Special stained specimen slides to identify organisms including interpretation and report | 25 | 21 |
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