Rudolf Otrusinik, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

95-292310-1205 Issued in UT

Practice address

1300 N 500 E
Suite 320
Logan, UT 84341-2408

Phone

(435) 755-8200

Fax

(435) 752-6094

NPI assigned

Aug 21, 2006

Last updated

Aug 13, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Cardiovascular Disease (Cardiology)

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ihc Health Services IncGroup PAC ID 1850209420, shared by 68 NPIs, 3,948 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health Logan Regional Hospital Hospital, Logan, UT, CCN 460015
• Bear River Valley Hospital Hospital, Tremonton, UT, CCN 460039
• Cassia Regional Hospital Hospital, Burley, ID, CCN 131326

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ihc Health Services Inc

  dba IMED Physicians Billing

  • Multi-Specialty Clinic/Center
  • Murray, UT
  • NPI 1629260880
  Medicare reassignment NPD
• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment NPD
• Cache Valley Cardiology PC

  • Specialist
  • Logan, UT
  • NPI 1043433246
  NPD
• Ihc Health Services Inc

  dba American Fork Hospital Physicians

  • Multi-Specialty Clinic/Center
  • American Fork, UT
  • NPI 1669420014
  NPD
• Ihc Health Services, Inc

  dba Memorial Clinic

  • Internal Medicine Physician
  • Salt Lake City, UT
  • NPI 1508904947
  NPD
• Ihc Health Services Inc

  dba Orem Community Hospital Physicians

  • Multi-Specialty Clinic/Center
  • Orem, UT
  • NPI 1588601124
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ihc Health Services Inc

  dba Intermountain Health Bear River Valley Hospital

  • General Acute Care Hospital
  • Tremonton, UT
  • NPI 1679582944
  Care Compare affiliation
• Ihc Health Services Inc

  dba Intermountain Health Logan Regional Hospital

  • General Acute Care Hospital
  • Logan, UT
  • NPI 1831108497
  Care Compare affiliation
• Ihc Health Services, Inc.

  dba Intermountain Health Cassia Regional Hospital

  • General Acute Care Hospital
  • Burley, ID
  • NPI 1497865315
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281657600000",
    "number": "1003922394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SLC",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "435-755-8200",
            "fax_number": "435-752-6094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N 500 E",
            "address_2": "SUITE 320",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412408",
            "telephone_number": "435-755-8200",
            "fax_number": "435-752-6094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTRUSINIK",
        "first_name": "RUDOLF",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2010-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "UT",
            "license": "95-292310-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "53687",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECTCARE",
            "identifier": "107008634101",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "581997",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "87-0569381",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "060053972",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805433000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ora Counseling
• David Orth, PHARMD
• Kylie Grace Ortiz, MOT, OTR/L
• Allison Michelle Orton
• Jillyn Alice Ostergaard, CMHC
• Benjamin Owens, OTR/L
• Krystopher B Oyler, LCSW
• Craig D Pabst, MD
• Emilee Packer, SLP
• Andrea Suzette Page, AUD

• Cardiovascular Disease Physician in Logan, UT
• Providers in Logan, UT by specialty
• Cardiovascular Disease Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.