NPIMap

Individual provider Active NPI

Rudiko Rusia, MD

  • Internal Medicine Physician
  • Fort Mill, SC
National Provider Identifier
1205509692
Registry record updated Jun 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
91168 Issued in SC
Practice address
1000 Wellness Way
Fort Mill, SC 29715-7315
Phone
(803) 802-3662
NPI assigned
Jul 30, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 91168 SC Primary

Addresses

Primary practice location

1000 Wellness Way
Fort Mill, SC 29715-7315

Mailing address

711 E Morehead St Apt 1235
Charlotte, NC 28202-3580
Phone (585) 360-9642

Other practice location 1

1555 Long Pond Rd
Rochester, NY 14626-4122
Phone (585) 723-7746

Other practice location 2

1561 Long Pond Rd Ste 206
Rochester, NY 14626-4135
Phone (585) 368-4800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20240612002598 SC Practitioner - Internal Medicine 6406398809 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Hospitalist Services PCGroup PAC ID 3476855420, 301 clinicians

Practice addresses (Care Compare)

222 Herlong Ave S
Rock Hill, SC 29732-1158
Phone (803) 329-1234

Hospital & facility affiliations

  • Piedmont Medical Center Hospital, Rock Hill, SC, CCN 420002
  • Atrium Health Pineville Hospital, Charlotte, NC, CCN 340098
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113
  • Musc Health Lancaster Medical Center Hospital, Lancaster, SC, CCN 420036

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
91168SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Hospitalist Services PC Internal Medicine CurrentSince Jul 1, 2024 Accepting new patients
Rochester General Hospital Past Accepting new patients
Amisub of South Carolina, Inc. Past Accepting new patients
The Unity Hospital of Rochester Past Accepting new patients

Locations

1000 Wellness Way
Fort Mill, SC 29715
Phone (803) 329-1234

809 82nd Pkwy
Myrtle Beach, SC 29572
Phone (843) 291-7182

222 Herlong Ave S
Rock Hill, SC 29732
Phone (803) 324-1950

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719100800000",
    "number": "1205509692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 E MOREHEAD ST APT 1235",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282023580",
            "telephone_number": "585-360-9642",
            "fax_number": "585-360-9642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 WELLNESS WAY",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297157315",
            "telephone_number": "803-802-3662"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1555 Long Pond Rd",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146264122",
            "country_code": "US",
            "telephone_number": "585-723-7746",
            "fax_number": "585-723-7834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1561 Long Pond Rd Ste 206",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146264135",
            "country_code": "US",
            "telephone_number": "585-368-4800",
            "fax_number": "585-368-4815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSIA",
        "first_name": "RUDIKO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-30",
        "last_updated": "2024-06-23",
        "certification_date": "2024-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "91168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Mill, SC

Sources for this page

Verify at the official NPI Registry.