Active NPI
Colin David Rudolph, M.D.
- Pediatric Gastroenterology Physician
- San Francisco, CA
National Provider Identifier
1073564548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Gastroenterology Physician
- License
- 42936
- Practice address
- 156 Parker Avenue
San Francisco, CA 94118-2608 - Phone
- (415) 317-6342
- NPI assigned
- May 12, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Gastroenterology Physician | 2080P0206X | 42936 | WI | Primary |
Addresses
Primary practice location
156 Parker Avenue
San Francisco, CA 94118-2608
Mailing address
156 Parker Avenue
San Francisco, CA 94118-2608
Phone (415) 317-6342
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34045500 | Medicaid | WI | |
| 004006261W | Other | HUMANA |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42936 | WI | MD | Pediatric Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641168000000",
"number": "1073564548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "156 PARKER AVENUE",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941182608",
"telephone_number": "415-317-6342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "156 PARKER AVENUE",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941182608",
"telephone_number": "415-317-6342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDOLPH",
"first_name": "COLIN",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-12",
"last_updated": "2022-01-03",
"certification_date": "2022-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0206X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Gastroenterology",
"state": "WI",
"license": "42936",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "34045500",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "004006261W",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.