Timothy J Ruetten, MD

Key facts

NPI

1194773499

Entity type

Individual (NPI type 1)

Primary specialty

Family Medicine Physician 207Q00000X

License

036087147 (IL)

Practice address

954 West State Street
Sycamore, IL 60118

Phone

(815) 895-9144

Fax

(815) 899-4234

NPI assigned

May 5, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 2

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.

• Edward Health Ventures Multi-Specialty Clinic/Center · Bolingbrook, IL · NPI 1962452912
  Medicare reassignment NPD IL
• Edward Health Ventures Specialist · Naperville, IL · NPI 1447501879
  NPD

Hospital & facility affiliations 2

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

• Kishwaukee Community Hospital General Acute Care Hospital · Dekalb, IL · NPI 1669534517
  Care Compare affiliation Hospital
• Saint Anthony Medical Center General Acute Care Hospital · Rockford, IL · NPI 1790739977
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Family Practice

Education

Rush Medical College of Rush University, 1991

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Medicine Kishwaukee Hospital Hospital · Dekalb, IL · CCN 140286
• Saint Anthony Medical Center Hospital · Rockford, IL · CCN 140233

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 26, 2021.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1194773499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "954 WEST STATE STREET",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "60118",
            "telephone_number": "815-895-9144",
            "fax_number": "815-899-4234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "954 WEST STATE STREET",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "60118",
            "telephone_number": "815-895-9144",
            "fax_number": "815-899-4234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUETTEN",
        "first_name": "TIMOTHY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036087147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036087147",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "truetten129480@direct.edward.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "954 West State Street",
            "city": "Sycamore",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sycamore, IL

• Dominique M Ross, LAT, ATC
• Kristina Lynn Wagner Ross, MSN, APRN, FNP-BC
• Allison Rothamer, SLP-A, A.A.S.
• Courtney Rowell II
• Catherine A Ruetten, MD
• Amanda Ruppert
• Madison Russell
• Amanda Kay Ryan
• Catherine Ryan, L.C.P.C.
• Courtney Allene Rzab

All providers in Sycamore, IL · Family Medicine Physician in Illinois