NPIMap

Individual provider Active NPI

Jack Rutkowski, MD

  • Internal Medicine Physician
  • Independence, OH
National Provider Identifier
1073602520
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35-088270 Issued in OH
Practice address
4400 Rockside Rd
Suite 2100
Independence, OH 44131-2109
Phone
(216) 573-1300
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35-088270 OH Primary

Addresses

Primary practice location

4400 Rockside Rd
Suite 2100
Independence, OH 44131-2109

Mailing address

4400 Rockside Rd
Suite 2100
Independence, OH 44131-2109
Phone (216) 573-1300

Other identifiers 5

IdentifierTypeStateIssuer
000000590092OtherOHANTHEM BLUE SHIELD
T88270OtherOHSUMMACARE
2698540MedicaidOH
000000500020OtherOHANTHEM
745390OtherOHBUCKEYE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061031000183 OH Practitioner - Internal Medicine 3274530514 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Two Brothers Enterprises IncGroup PAC ID 0143384438, 2 clinicians

Practice addresses (Care Compare)

4400 Rockside Rd
Suite 2100
Independence, OH 44131-2176
Phone (216) 573-1300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-088270OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Two Brothers Enterprises Inc Internal Medicine CurrentSince Nov 6, 2006 Accepting new patients
Marymount Primary Care Services Inc Past Accepting new patients

Locations

4400 Rockside Rd
Ste 2100
Independence, OH 44131
Phone (216) 328-8911

Interoperability endpoints

  • Direct secure messaging: jrutkowski37513@ehrdirect.uhhospitals.org

Organizations & group practices 2

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.

Hospital & facility affiliations 12

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1073602520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 ROCKSIDE RD",
            "address_2": "SUITE 2100",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312109",
            "telephone_number": "216-573-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 ROCKSIDE RD",
            "address_2": "SUITE 2100",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312109",
            "telephone_number": "216-573-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTKOWSKI",
        "first_name": "JACK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-088270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE SHIELD",
            "identifier": "000000590092",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUMMACARE",
            "identifier": "T88270",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2698540",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000500020",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE",
            "identifier": "745390",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, OH

Sources for this page

Verify at the official NPI Registry.