Tatyana Eastlyn Jack Ruddock, CNM, ARNP

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

9314525 Issued in FL

Practice address

1625 SE 3Rd Ave Ste 502
Ft Lauderdale, FL 33316-2521

Phone

(954) 581-8706

NPI assigned

Mar 2, 2018

Last updated

Mar 2, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Certified Nurse Midwife (CNM)

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11823/brand/2/csg/41/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Obhg California, P.C.

  • Obstetrics & Gynecology Physician
  • Greenville, SC
  • NPI 1215258892

  CA

  Medicare reassignment NPD
• San Luis Walk-in Clinic, Inc.

  • Rural Health Clinic/Center
  • San Luis, AZ
  • NPI 1104228337
  Medicare reassignment NPD
• San Luis Walk-in Clinic, Inc.

  dba Children Integrated Care Services

  • Rural Health Clinic/Center
  • Somerton, AZ
  • NPI 1063274868
  NPD
• San Luis Walk-in Clinic, Inc.

  • Rural Health Clinic/Center
  • San Luis, AZ
  • NPI 1447865654
  NPD
• Vitalmd Group Holding LLC

  • Obstetrics & Gynecology Physician
  • Miami, FL
  • NPI 1871572032
  NPD (past)
• San Luis Walk-in Clinic, Inc.

  • Rural Health Clinic/Center
  • Somerton, AZ
  • NPI 1003991506
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519948800000",
    "number": "1144722422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7331 NW 35TH ST",
            "city": "LAUDERHILL",
            "state": "FL",
            "postal_code": "333194913",
            "telephone_number": "954-529-1607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SE 3RD AVE STE 502",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162521",
            "telephone_number": "954-581-8706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK RUDDOCK",
        "first_name": "TATYANA",
        "middle_name": "EASTLYN",
        "credential": "CNM, ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-02",
        "last_updated": "2018-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "FL",
            "license": "9314525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J3 Revenue Cycle Management
• Tariq Majed Jaber, MD
• Sergio Julio Jacas, D.M.D
• Marina Alves Jacintho de Mello, M.D.
• Jack M Trainor MD PA
• James E. Jack, DC
• Sidney Alice Jackett
• Brittany Janay Jackson
• Crashawn Toya Jackson, NURSE AIDE
• Ian Jackson, LMHC

• Advanced Practice Midwife in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Advanced Practice Midwife in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.