NPIMap

Individual provider Active NPI

Councill C Rudolph, MD

  • Surgery Physician
  • Manchester, TN
National Provider Identifier
1194760660
Registry record updated Apr 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD0000025899 Issued in TN
Practice address
822 McArthur St
Manchester, TN 37355-2324
Phone
(931) 723-7121
Fax
(931) 723-7133
NPI assigned
Jun 18, 2006
Last updated
Apr 14, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD0000025899 TN Primary

Addresses

Primary practice location

822 McArthur St
Manchester, TN 37355-2324

Mailing address

15 Veterans Dr
Decherd, TN 37324-3887
Phone (931) 962-2273

Other identifiers 1

IdentifierTypeStateIssuer
3091133MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Oct 1, 2015 through Oct 1, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD0000025899TNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Amg-Southern Tennessee LLC Past Accepting new patients
Preferred Pain Center of Grundy County PastSince Apr 3, 2013 Accepting new patients
Patrick R. Greer, MD, PLLC Surgery PastSince Dec 1, 2008 Accepting new patients
Cumberland Healthcare Group, PLLC Surgery Past Accepting new patients
McMinnville Pain Relief Center PastSince Jan 1, 2013 Accepting new patients

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460592000000",
    "number": "1194760660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 VETERANS DR",
            "city": "DECHERD",
            "state": "TN",
            "postal_code": "373243887",
            "telephone_number": "931-962-2273",
            "fax_number": "931-962-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 MCARTHUR ST",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373552324",
            "telephone_number": "931-723-7121",
            "fax_number": "931-723-7133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "COUNCILL",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2016-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "MD0000025899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3091133",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, TN

Sources for this page

Verify at the official NPI Registry.