NPIMap

Individual provider Active NPI

Rudolph Richard Wencl, PA-C

  • Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1184784530
Registry record updated Apr 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0001485 Issued in CO
Practice address
600 S 21St St
Colorado Springs, CO 80904-3762
Phone
(719) 522-1133
NPI assigned
Dec 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2026

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 PA.0001485 CO Primary

Addresses

Primary practice location

600 S 21St St
Colorado Springs, CO 80904-3762

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Other identifiers 1

IdentifierTypeStateIssuer
9000204150MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140127000389 CO Practitioner - Physician Assistant 0345413449 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

Colorado Springs, CO 80903
Phone (719) 538-2900

1625 Medical Ctr PT
Suite 290
Colorado Springs, CO 80907-8722
Phone (719) 635-5148

1633 Medical Ctr PT
Colorado Springs, CO 80907-5700
Phone (719) 598-9446

700 W US Hwy 24
Woodland Park, CO 80863-8975
Phone (719) 687-6022

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1485COMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Optumcare Colorado Medical Group LLC CurrentSince May 1, 2021 Accepting new patients
Optumcare Colorado Medical Group LLC CurrentSince May 1, 2021 Accepting new patients
Optumcare Colorado Medical Group LLC Past Accepting new patients
Pridemark Paramedic Services, LLC Past Accepting new patients

Locations

1625 Medical Center Pt
Ste 290
Colorado Springs, CO 80907
Phone (719) 635-5148

600 S 21st St
Colorado Springs, CO 80904
Phone (719) 635-5900

2 S Cascade Ave
Ste 140
Colorado Springs, CO 80903
Phone (719) 538-2900

Interoperability endpoints

  • Direct secure messaging: rwencl121010@westdirect.optum.com

Organizations & group practices 4

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.

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776384000000",
    "number": "1184784530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S 21ST ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809043762",
            "telephone_number": "719-522-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENCL",
        "first_name": "RUDOLPH",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0001485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000204150",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.