Caitlyn Mae Rerucha, MD, MSED, FAAFP

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

0101253730 Issued in VA

Practice address

36065 Santa Fe Ave
Fort Cavazos, TX 76544-5060

Phone

(254) 288-8280

NPI assigned

Jul 7, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Caitlyn Mae Faller Former name

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1043507213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36065 SANTA FE AVE",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "765445060",
            "telephone_number": "254-288-8280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36065 SANTA FE AVE",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "765445060",
            "telephone_number": "254-288-8280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RERUCHA",
        "first_name": "CAITLYN",
        "middle_name": "MAE",
        "name_prefix": "Dr.",
        "credential": "MD, MSED, FAAFP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-07",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "VA",
            "license": "0101253730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAITLYN",
            "last_name": "FALLER",
            "middle_name": "MAE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Timothy H. Ray, D.D.S.
• Dominic John Raymond III, MD
• Sean Clark Reilly, M.D.
• Remark Buccola LLC (US Cryotherapy Fort Hood)
• Daniel Gene Rendeiro, PT, DSC, OCS
• Lillian Resnick, CRNA
• Adriana E Rhodes, PHARM D, MBA, BS
• Matthew E Ricci, MD
• Mary Claire Ridenoure, LCSW
• Cindy Latrice Roberts, FNP

• Sports Medicine (Family Medicine) Physician in Fort Cavazos, TX
• Providers in Fort Cavazos, TX by specialty
• Sports Medicine (Family Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; 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.

Verify at the official NPI Registry.