NPIMap

Organization Active NPI

Rucker Medical Group Inc

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1174801054
Registry record updated Jul 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A34349 Issued in CA
Legal business name
RUCKER MEDICAL GROUP INC
Practice address
5265 Fountain Ave
Suite 1a
Los Angeles, CA 90029-1300
Phone
(323) 662-7764
Fax
(323) 662-7714
NPI assigned
Jul 27, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2011

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

Authorized official

Name
Dr. Burnett Rucker, MDNPI 1376553008
Title
Medical Director
Phone
(323) 662-7764

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X A34349 CA Primary

Addresses

Primary practice location

5265 Fountain Ave
Suite 1a
Los Angeles, CA 90029-1300

Mailing address

5265 Fountain Ave
Suite 1a
Los Angeles, CA 90029-1300
Phone (323) 662-7764

National Provider Directory

National Provider Directory

Locations

5265 Fountain Ave
#1A
Los Angeles, CA 90029
Phone (323) 622-7764

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1311724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311724800000",
    "number": "1174801054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5265 FOUNTAIN AVE",
            "address_2": "SUITE 1A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900291300",
            "telephone_number": "323-662-7764",
            "fax_number": "323-662-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5265 FOUNTAIN AVE",
            "address_2": "SUITE 1A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900291300",
            "telephone_number": "323-662-7764",
            "fax_number": "323-662-7714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUCKER MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-27",
        "last_updated": "2011-07-27",
        "status": "A",
        "authorized_official_last_name": "RUCKER",
        "authorized_official_first_name": "BURNETT",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "323-662-7764",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A34349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.