NPIMap

Individual provider Active NPI

Patrick Donohue Rudersdorf, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Lakewood, CO
National Provider Identifier
1033374186
Registry record updated Oct 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
DR.0055303 Issued in CO
Practice address
11700 W 2ND PL
Suite 280
Lakewood, CO 80228-1704
Phone
(720) 321-8680
Fax
(720) 321-8681
NPI assigned
Jul 28, 2008
Last updated
Oct 30, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2015

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X DR.0055303 CO
Surgery Physician 208600000X A113303 CA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X DR.0055303 CO Primary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X A113303 CA

Addresses

Primary practice location

11700 W 2ND PL
Suite 280
Lakewood, CO 80228-1704

Mailing address

11700 W 2ND PL
Suite 280
Lakewood, CO 80228-1704
Phone (720) 321-8680

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150717001086 CO Practitioner - Thoracic SurgeryPractitioner - General Surgery 4183937337 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Thoracic SurgeryAlso: General Surgery
Education
Creighton University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

11600 W 2ND PL
Lakewood, CO 80228-1527

11650 W 2ND PL
Lakewood, CO 80228-1527

11700 W 2ND PL
Suite 280
Lakewood, CO 80228-1717
Phone (720) 321-8680

41 State Hwy 67
Woodland Park, CO 80863-5008
Phone (719) 776-4780

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.06 of 100Reported as group
Quality
89.53
Promoting interoperability
100
Improvement activities
40
Cost
74

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR.0055303COMDSurgery Physician
A113303CAMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Health Initiatives Colorado Thoracic Surgery (Cardiothoracic Vascular Surgery) Current Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Jul 15, 2015 Accepting new patients
Valley View Hospital Association CurrentSince Jan 1, 2019 Accepting new patients
Valley View Hospital Association CurrentSince Jan 1, 2019 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Jul 15, 2015 Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients

Locations

1906 Blake Ave
Glenwood Springs, CO 81601
Phone (970) 384-7033

11700 W 2nd Pl
Ste 280
Lakewood, CO 80228
Phone (720) 321-8680

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

Networks

  • CO HMO
  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a
  • CO HMO D-SNP
  • CO HMO C-SNP

Organizations & group practices 7

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446163200000",
    "number": "1033374186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11700 W 2ND PL",
            "address_2": "SUITE 280",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802281704",
            "telephone_number": "720-321-8680",
            "fax_number": "720-321-8681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11700 W 2ND PL",
            "address_2": "SUITE 280",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802281704",
            "telephone_number": "720-321-8680",
            "fax_number": "720-321-8681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDERSDORF",
        "first_name": "PATRICK",
        "middle_name": "DONOHUE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-28",
        "last_updated": "2015-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CO",
            "license": "DR.0055303",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A113303",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CO",
            "license": "DR.0055303",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "A113303",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.