Rudolf W Cisco, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

000596 Issued in GA

Practice address

1224 Sherwood Park Dr NE
Gainesville, GA 30501-3445

Phone

(770) 287-0606

Fax

(770) 287-0159

NPI assigned

Jul 15, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Podiatry

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Village Podiatry Group LLCGroup PAC ID 4587646971, 51 clinicians

Village Podiatry Group II LLCGroup PAC ID 7719218437, 70 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northeast Georgia Medical Center Lumpkin Hospital, Dahlonega, GA, CCN 110237
• Northeast Georgia Medical Center, Inc Hospital, Gainesville, GA, CCN 110029

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rudolf.cisco.1@4399.direct.athenahealth.com

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.

• Village Podiatry Group II, LLC.

  • Foot & Ankle Surgery Podiatrist
  • Atlanta, GA
  • NPI 1427540699
  Medicare reassignment Care Compare group NPD
• Village Podiatry Group, L.L.C.

  • Podiatrist
  • Roswell, GA
  • NPI 1508846718
  Medicare reassignment Care Compare group NPD
• Village Podiatry Group II, LLC.

  • Podiatrist
  • Royston, GA
  • NPI 1659918969
  NPD
• Village Podiatry Group LLC

  • Foot & Ankle Surgery Podiatrist
  • Covington, GA
  • NPI 1942036314
  NPD

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

• NGMC Lumpkin, LLC

  • General Acute Care Hospital
  • Dahlonega, GA
  • NPI 1083174973
  Care Compare affiliation
• Northeast Georgia Medical Center, Inc.

  • General Acute Care Hospital
  • Gainesville, GA
  • NPI 1427055821
  Care Compare affiliation

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294185600000",
    "number": "1043236706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 SHERWOOD PARK DR NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013445",
            "telephone_number": "770-287-0606",
            "fax_number": "770-287-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 SHERWOOD PARK DR NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013445",
            "telephone_number": "770-287-0606",
            "fax_number": "770-287-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CISCO",
        "first_name": "RUDOLF",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2011-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "000596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00409274A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christy Meeks-Gaines
• Jacqueline H Church, LDO
• Alison Kyle Chwalibog
• Eugene Clarence Cindea, MD
• Sorin George Circa, PA
• Isabel Annaly Cisneros
• City of Gainesville
• Nathan Drew City, D.O.
• Misty Mullins Clackum, RD, CSP, LDN
• Carrie Leigh Clark, MS, PT

• Foot & Ankle Surgery Podiatrist in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Foot & Ankle Surgery Podiatrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.