Thomas Ruffalo, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

657-023 Issued in WI

Practice address

791 Summit Ave
Oconomowoc, WI 53066-3844

Phone

(262) 569-9119

NPI assigned

Sep 15, 2005

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Physician Associates of Wisconsin, SC

  • Clinic/Center
  • Milwaukee, WI
  • NPI 1437472172
  NPD (past)

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063407013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 S SAWYER RD",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530669243",
            "telephone_number": "262-244-7693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "791 SUMMIT AVE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663844",
            "telephone_number": "262-569-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUFFALO",
        "first_name": "THOMAS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "657-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42936300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roundys
• Roundys Supermarkets Inc
• Roundys Supermarkets Inc
• Angelica M Rowin-Fox, FNP
• Kim R. Ruffalo, OTR, CLT-LANA
• Samantha Jean Ruiz, D.D.S.
• Joan Carol Russo, PH.D.
• Jeffrey Daniel Rutkowski, D.C.
• Jan E Rutledge, RN
• M Fay Sanders, LCSW

• Physician Assistant in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.