Active NPI
Penny S Rudy, RD, LD
- Registered Dietitian
- Centerburg, OH
National Provider Identifier
1033788385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 4256 Simmons Church Rd
Centerburg, OH 43011-9426 - Phone
- (740) 771-1112
- NPI assigned
- Jun 22, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | |||
| Obesity and Weight Management Nutrition Registered Dietitian | 133VN1201X | |||
| Registered Dietitian | 133V00000X | OH | Primary |
Addresses
Primary practice location
4256 Simmons Church Rd
Centerburg, OH 43011-9426
Mailing address
4256 Simmons Church Rd
Centerburg, OH 43011-9426
Phone (740) 771-1112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Bachelor of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731196800000",
"number": "1033788385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4256 SIMMONS CHURCH RD",
"city": "CENTERBURG",
"state": "OH",
"postal_code": "430119426",
"telephone_number": "740-771-1112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4256 SIMMONS CHURCH RD",
"city": "CENTERBURG",
"state": "OH",
"postal_code": "430119426",
"telephone_number": "740-771-1112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDY",
"first_name": "PENNY",
"middle_name": "S",
"name_prefix": "Mrs.",
"credential": "RD, LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-22",
"last_updated": "2024-11-10",
"certification_date": "2024-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": false
},
{
"code": "133VN1201X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
"state": null,
"license": null,
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": "OH",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centerburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.