Active NPI
Gerald John Rutecki, M.D.
- Nephrology Physician
- Port St Lucie, FL
National Provider Identifier
1013054592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- ME14730
- Practice address
- 473 NW Blue Lake Dr
Port St Lucie, FL 34986-3573 - Phone
- (772) 336-8039
- NPI assigned
- Jan 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | ME14730 | FL | Primary |
Addresses
Primary practice location
473 NW Blue Lake Dr
Port St Lucie, FL 34986-3573
Mailing address
PO Box 2926
Vero Beach, FL 32961-2926
Phone (772) 713-3910
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160225002598 | FL | Order and Referring Only - Internal Medicine | 3971808171 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME14730 | FL | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013054592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2926",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329612926",
"telephone_number": "772-713-3910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "473 NW BLUE LAKE DR",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349863573",
"telephone_number": "772-336-8039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUTECKI",
"first_name": "GERALD",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "FL",
"license": "ME14730",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.