Organization Active NPI

Richard Rouder, DPM, PC

Doing business as Si Podiatry

  • Foot Surgery Podiatrist
  • Staten Island, NY
National Provider Identifier
1205876018
Registry record updated Jul 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
N005371 Issued in NY
Legal business name
RICHARD ROUDER, DPM, PC
Doing business as
Si Podiatry
Practice address
1855 Richmond Ave
Staten Island, NY 10314-3912
Phone
(718) 556-5550
Fax
(718) 556-7868
NPI assigned
Jun 8, 2006
Last updated
Jul 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2008

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

Authorized official

Name
Dr. Richard Rouder, DPM
Title
President
Phone
(718) 556-5550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X N005371 NY Primary

Addresses

Primary practice location

1855 Richmond Ave
Staten Island, NY 10314-3912

Mailing address

1855 Richmond Ave
Staten Island, NY 10314-3912
Phone (718) 556-5550

Other identifiers 1

IdentifierTypeStateIssuer
05402OtherNYGHI MEDICARE

Other names 1

  • SI PODIATRY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080430000670 NY Part B Supplier - Clinic/Group Practice 6002995115 Receives reassigned benefits from 2 practitioners
Practice locations: Staten Island, NY
O20100930012400 NY DME Supplier - Physician - Podiatry 6002995115 Practice locations: Staten Island, NY

National Provider Directory

National Provider Directory

Locations

1500 Victory Blvd
Staten Island, NY 10301
Phone (718) 556-5550

1855 Richmond Ave
Ste 104
Staten Island, NY 10314
Phone (718) 556-5550

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217203200000",
    "number": "1205876018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 RICHMOND AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143912",
            "telephone_number": "718-556-5550",
            "fax_number": "718-556-7868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 RICHMOND AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143912",
            "telephone_number": "718-556-5550",
            "fax_number": "718-556-7868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD ROUDER, DPM, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2008-07-28",
        "status": "A",
        "authorized_official_last_name": "ROUDER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-556-5550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NY",
            "license": "N005371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI MEDICARE",
            "identifier": "05402",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SI PODIATRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.