Individual provider Active NPI

Lori B Rutledge, NP

  • Acute Care Nurse Practitioner
  • Williamsburg, VA
National Provider Identifier
1144324864
Registry record updated Nov 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
0024167044 Issued in VA
Practice address
1602 Promenade LN
Williamsburg, VA 23185-3450
Phone
(804) 898-1441
NPI assigned
Sep 12, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 0024167044 VA Primary

Addresses

Primary practice location

1602 Promenade LN
Williamsburg, VA 23185-3450

Mailing address

41800 W 11 Mile Rd
Novi, MI 48375-1872
Phone (248) 660-1220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TX, OH, MI4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20061031000179 VA Practitioner - Nurse Practitioner 0648277988
I20230801004523 TX Practitioner - Nurse Practitioner 0648277988 Reassigns benefits to 1 organization
I20230804002483 OH Practitioner - Nurse Practitioner 0648277988
I20230809001078 MI Practitioner - Nurse Practitioner 0648277988 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024167044VAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Theoria Medical CurrentSince Jun 18, 2023 Accepting new patients
Complexcare Medical Group Midwest M PLLC PastSince Nov 5, 2023 Accepting new patients
Complexcare Medical Group Southeast H PLLC PastSince Nov 5, 2023 Accepting new patients

Locations

5655 Clarkston Rd
Clarkston, MI 48348
Phone (810) 623-5216

3139 E Baldwin Rd
Grand Blanc, MI 48439
Phone (810) 445-5300

1030 High St
Worthington, OH 43085
Phone (614) 876-7356

3737 N Garland Ave
Garland, TX 75040
Phone (214) 315-6310

2712 Hurstview Dr
Hurst, TX 76054
Phone (817) 281-6407

Interoperability endpoints

  • Direct secure messaging: lori.rutledge@552337174953988.direct.elationemr.com

Organizations & group practices 3

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": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699056000000",
    "number": "1144324864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41800 W 11 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483751872",
            "telephone_number": "248-660-1220",
            "fax_number": "248-218-9996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 PROMENADE LN",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231853450",
            "telephone_number": "804-898-1441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTLEDGE",
        "first_name": "LORI",
        "middle_name": "B",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-12",
        "last_updated": "2023-11-04",
        "certification_date": "2023-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "VA",
            "license": "0024167044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, VA

Sources for this page

Verify at the official NPI Registry.