Active NPI
Leanna Rae Rucker, MD
- Student in an Organized Health Care Education/Training Program
- Philadelphia, PA
National Provider Identifier
1235768953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 111 S 11TH St
Philadelphia, PA 19107-4870 - Phone
- (215) 955-6000
- NPI assigned
- Apr 4, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
111 S 11TH St
Philadelphia, PA 19107-4870
Mailing address
1080 Crestbrook Dr
Riverside, CA 92506-5664
Phone (951) 801-0495
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241009000257 | PA | Order and Referring Only - Gastroenterology | 6901337310 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- lrucker591905@soc.inova.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719360000000",
"number": "1235768953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1080 CRESTBROOK DR",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925065664",
"telephone_number": "951-801-0495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 S 11TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191074870",
"telephone_number": "215-955-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUCKER",
"first_name": "LEANNA",
"middle_name": "RAE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-04",
"last_updated": "2024-06-26",
"certification_date": "2024-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.