Active NPI
Phillip Paul Ruppert, PSYD
- Clinical Psychologist
- The Villages, FL
National Provider Identifier
1063426575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1057
- Practice address
- 3309 Wedgewood LN
The Villages, FL 32162-7177 - Phone
- (352) 391-1220
- Fax
- (352) 391-9247
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1057057 | WI | |
| Psychologist | 103T00000X | 1057 | WI | |
| Clinical Psychologist | 103TC0700X | 1057 | WI | Primary |
Addresses
Primary practice location
3309 Wedgewood LN
The Villages, FL 32162-7177
Mailing address
1950 Laurel Manor Dr
BLDG. 240
The Villages, FL 32162-5603
Phone (352) 391-1220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39045600 | Medicaid | WI |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1057057 | WI | MD | Psychologist |
| 1057 | WI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health Psychology Associates, S.C. | Psychologist | 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": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257984000000",
"number": "1063426575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1950 LAUREL MANOR DR",
"address_2": "BLDG. 240",
"city": "THE VILLAGES",
"state": "FL",
"postal_code": "321625603",
"telephone_number": "352-391-1220",
"fax_number": "352-391-9247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3309 WEDGEWOOD LN",
"city": "THE VILLAGES",
"state": "FL",
"postal_code": "321627177",
"telephone_number": "352-391-1220",
"fax_number": "352-391-9247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUPPERT",
"first_name": "PHILLIP",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2009-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "1057057",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "1057",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "1057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39045600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in The Villages, FL
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- Richard W Rozensky, DDS
- Shaun Matthew Rudi, CRNA
- Tara Piner Rushing, APRN
- Amanda Kathleen Russ, DNP, APRN
- James Russell, O.D.
- Daniel Ryan
- Denis Dean Sabins, DDS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.