Individual provider Active NPI

Kaitlyn Devon Rudman

  • Physician Assistant
  • Glen Mills, PA
National Provider Identifier
1184443855
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
50 Beech Tree Dr
Glen Mills, PA 19342-1173
Phone
(484) 886-8522
NPI assigned
Oct 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

50 Beech Tree Dr
Glen Mills, PA 19342-1173

Mailing address

50 Beech Tree Dr
Glen Mills, PA 19342-1173

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250903000181 NY Practitioner - Physician Assistant 8921509662 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bobby Buka, M.D., P.C.Group PAC ID 0547351140, 140 clinicians

Practice addresses (Care Compare)

214 Sullivan St
New York, NY 10012-1354
Phone (212) 385-3700

220 Front St
New York, NY 10038-2033
Phone (212) 385-3700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bobby Buka, M.D., P.C. CurrentSince May 25, 2025 Accepting new patients
Out East Medical PastSince Jun 15, 2021 Accepting new patients
Derm Specs of PA PLLC PastSince Feb 25, 2024 Accepting new patients

Locations

1027 46th Ave
Fl 1
Long Island City, NY 11101

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BFCDAA

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": "1728432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1184443855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 BEECH TREE DR",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "193421173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 BEECH TREE DR",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "193421173",
            "telephone_number": "484-886-8522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDMAN",
        "first_name": "KAITLYN",
        "middle_name": "DEVON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-09",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Mills, PA

Sources for this page

Verify at the official NPI Registry.