Active NPI
William Kennard Rundell, M.D.
- Vascular Surgery Physician
- Dayton, OH
National Provider Identifier
1174595748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 35043493R
- Practice address
- 1520 S. Main Street
Suite 210
Dayton, OH 45409-2675 - Phone
- (937) 228-4126
- Fax
- (937) 228-0247
- NPI assigned
- Feb 7, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 35043493R | OH | Primary |
Addresses
Primary practice location
1520 S. Main Street
Suite 210
Dayton, OH 45409-2675
Mailing address
30 E. Apple St.
Ste 5253
Dayton, OH 45409
Phone (937) 208-2552
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0413065 | Medicaid | OH |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35043493R | OH | MD | Vascular Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wright State Physicians Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Ambulatory Surgical Clinic/Center
- Dayton, OH
- NPI 1649447582
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292803200000",
"number": "1174595748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 E. APPLE ST.",
"address_2": "STE 5253",
"city": "DAYTON",
"state": "OH",
"postal_code": "45409",
"telephone_number": "937-208-2552",
"fax_number": "937-208-4286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1520 S. MAIN STREET",
"address_2": "SUITE 210",
"city": "DAYTON",
"state": "OH",
"postal_code": "454092675",
"telephone_number": "937-228-4126",
"fax_number": "937-228-0247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUNDELL",
"first_name": "WILLIAM",
"middle_name": "KENNARD",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-07",
"last_updated": "2010-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "OH",
"license": "35043493R",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0413065",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.