Active NPI
Ladd Douglas Rutherford Jr., PA-C
- Medical Physician Assistant
- Shelton, WA
National Provider Identifier
1235809005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 1701 N 13TH St
Shelton, WA 98584-2077 - Phone
- (360) 426-2653
- Fax
- (888) 985-0168
- NPI assigned
- Sep 14, 2021
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | Primary |
Addresses
Primary practice location
1701 N 13TH St
Shelton, WA 98584-2077
Mailing address
1701 N 13TH St
Shelton, WA 98584-2077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- University of Washington School of Medicine, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2300 Kati CT
Shelton, WA 98584-1926
901 Mountain View Dr
Shelton, WA 98584-4401
Phone (360) 426-1611
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Public Hospital District No 1 of Mason County | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Critical Access Hospital
- Shelton, WA
- NPI 1760568752
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Shelton, WA
- NPI 1760568752
-
- Foot & Ankle Surgery Podiatrist
- Shelton, WA
- NPI 1437486248
Hospital
-
- Surgery Physician
- Shelton, WA
- NPI 1639339666
Hospital
-
- Ophthalmologic Surgery Clinic/Center
- Shelton, WA
- NPI 1922196609
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673827200000",
"number": "1235809005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 N 13TH ST",
"city": "SHELTON",
"state": "WA",
"postal_code": "985842077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 N 13TH ST",
"city": "SHELTON",
"state": "WA",
"postal_code": "985842077",
"telephone_number": "360-426-2653",
"fax_number": "888-985-0168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUTHERFORD",
"first_name": "LADD",
"middle_name": "DOUGLAS",
"name_suffix": "Jr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-14",
"last_updated": "2023-01-16",
"certification_date": "2023-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.