Active NPI
Alexandria Ruzicka, PA-C
- Physician Assistant
- Alton, IL
National Provider Identifier
1104247741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085.004855
- Practice address
- 4411 Alby Street
Alton, IL 62002 - Phone
- (618) 474-8052
- NPI assigned
- Dec 29, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085.004855 | IL | Primary |
Addresses
Primary practice location
4411 Alby Street
Alton, IL 62002
Mailing address
4411 Alby Street
Alton, IL 62002
Phone (618) 474-8052
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085.004855 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403049600000",
"number": "1104247741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4411 ALBY STREET",
"city": "ALTON",
"state": "IL",
"postal_code": "62002",
"telephone_number": "618-474-8052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4411 ALBY STREET",
"city": "ALTON",
"state": "IL",
"postal_code": "62002",
"telephone_number": "618-474-8052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUZICKA",
"first_name": "ALEXANDRIA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-29",
"last_updated": "2014-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085.004855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.