Individual provider Active NPI

John G Rupolo, DC

  • Nutrition Chiropractor
  • Floral Park, NY
National Provider Identifier
1184706236
Registry record updated Nov 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nutrition ChiropractorTaxonomy code 111NN1001X
License
1883X-1 Issued in NY
Practice address
148 Tulip Ave
Floral Park, NY 11001-2705
Phone
(516) 354-4310
Fax
(516) 328-7019
NPI assigned
Oct 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Chiropractor 111NN1001X 1883X-1 NY Primary

Addresses

Primary practice location

148 Tulip Ave
Floral Park, NY 11001-2705

Mailing address

148 Tulip Ave
Floral Park, NY 11001-2705
Phone (516) 354-4310

Other identifiers 1

IdentifierTypeStateIssuer
X01701OtherNYBLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110607000363 NY Practitioner - Chiropractic 5395922025 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

148 Tulip Ave
FL 1
Floral Park, NY 11001-2766
Phone (516) 354-4310

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1883X-1NYMDNutrition Chiropractor
001883NYMDArt Therapist

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.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258070400000",
    "number": "1184706236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 TULIP AVE",
            "city": "FLORAL PARK",
            "state": "NY",
            "postal_code": "110012705",
            "telephone_number": "516-354-4310",
            "fax_number": "516-328-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 TULIP AVE",
            "city": "FLORAL PARK",
            "state": "NY",
            "postal_code": "110012705",
            "telephone_number": "516-354-4310",
            "fax_number": "516-328-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUPOLO",
        "first_name": "JOHN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2009-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "NY",
            "license": "1883X-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "X01701",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Floral Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.