Individual provider Active NPI

Stephen M Rudawski, DO

  • Family Medicine Physician
  • Urbana, IL
National Provider Identifier
1053403055
Registry record updated Dec 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036115719 Issued in IL
Practice address
611 W. Park St.
Urbana, IL 61801-2500
Phone
(217) 383-3170
Fax
(217) 383-7650
NPI assigned
Sep 28, 2006
Last updated
Dec 4, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036115719 IL Primary

Addresses

Primary practice location

611 W. Park St.
Urbana, IL 61801-2500

Mailing address

611 W. Park St.
BWPC
Urbana, IL 61801-2500
Phone (217) 383-6792

Other identifiers 2

IdentifierTypeStateIssuer
P00362629OtherILRAILROAD
0533210001OtherILDMERC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20061201000077 IL Practitioner - Family Practice 7315945243 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

516 W Madison St
Danville, IL 61832-5657

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hoopeston Community Memorial Hospital Family Medicine CurrentSince Jul 30, 2023 Accepting new patients
Carle Health Medical Group Family Medicine CurrentSince Apr 1, 2010 Accepting new patients
Hoopeston Community Memorial Hospital CurrentSince Jul 30, 2023 Accepting new patients
Carle West Physician Group Inc Family Medicine CurrentSince Oct 20, 2020 Accepting new patients
Hoopeston Community Memorial Hospital Current Accepting new patients
Carle Health Care Incorporated Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

2204 Eastland Dr
Bloomington, IL 61704
Phone (309) 662-9461

3024 E Empire St
Ste 3A
Bloomington, IL 61704
Phone (309) 556-7700

701 E Orange St
Hoopeston, IL 60942
Phone (217) 283-5531

1001 Heather Dr
Mahomet, IL 61853
Phone (217) 586-2317

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

810 W Anthony Dr
Urbana, IL 61802
Phone (217) 326-2911

Interoperability endpoints

  • Direct secure messaging: srudawskido121096@carlehiedirect.net

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417651200000",
    "number": "1053403055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W. PARK ST.",
            "address_2": "BWPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012500",
            "telephone_number": "217-383-6792",
            "fax_number": "217-383-7650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W. PARK ST.",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012500",
            "telephone_number": "217-383-3170",
            "fax_number": "217-383-7650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDAWSKI",
        "first_name": "STEPHEN",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2014-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036115719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00362629",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0533210001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

Verify at the official NPI Registry.