Active NPI
Susan Kimberly Moore Rucker, MD
- Pediatrics Physician
- Athens, TN
National Provider Identifier
1104967306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD28936
- Practice address
- 500 Decatur Pike
Athens, TN 37303-2514 - Phone
- (423) 745-2500
- Fax
- (423) 745-2571
- NPI assigned
- Feb 9, 2007
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD28936 | TN | Primary |
Addresses
Primary practice location
500 Decatur Pike
Athens, TN 37303-2514
Mailing address
PO Box 294
Athens, TN 37371-0294
Phone (423) 745-2500
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD28936 | TN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Covenant Pediatrics, PLLC | Pediatrics | Past | Accepting new patients |
| Cherokee Medical Group PC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- susan.rucker@covpeds.directbygreenway.com
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104967306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 294",
"city": "ATHENS",
"state": "TN",
"postal_code": "373710294",
"telephone_number": "423-745-2500",
"fax_number": "423-745-2571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 DECATUR PIKE",
"city": "ATHENS",
"state": "TN",
"postal_code": "373032514",
"telephone_number": "423-745-2500",
"fax_number": "423-745-2571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE RUCKER",
"first_name": "SUSAN",
"middle_name": "KIMBERLY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TN",
"license": "MD28936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, TN
Sources for this page
- 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.