Individual provider Active NPI

Brian Rutledge, M.D.

  • Gastroenterology Physician
  • Detroit, MI
National Provider Identifier
1245658202
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
T6700 Issued in TX
Practice address
4201 Saint Antoine St Ste 5C
Detroit, MI 48201-2153
Phone
(313) 577-5030
Fax
(313) 745-4707
NPI assigned
Apr 6, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301105717 MI
Gastroenterology Physician 207RG0100X T6700 TX Primary

Addresses

Primary practice location

4201 Saint Antoine St Ste 5C
Detroit, MI 48201-2153

Mailing address

1560 E Maple Rd Ste 400
Troy, MI 48083-1135
Phone (313) 745-4525

Other practice location 1

4201 Saint Antoine St
Suite 2E
Detroit, MI 48201-2153
Phone (313) 745-4525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170714000351 MI Practitioner - HospitalistPractitioner - Internal Medicine 5294036190 Reassigns benefits to 1 organization
I20220614001079 TX Practitioner - Gastroenterology 5294036190 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Wayne State University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gastroenterology Consultants of South Texas, PLLCGroup PAC ID 3274624937, 42 clinicians

Practice addresses (Care Compare)

512 Victoria LN
Suite 2
Harlingen, TX 78550-3227
Phone (956) 365-4400

720 N 77 Sunshinestrip
Harlingen, TX 78550-8848
Phone (956) 365-4400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy177
Upper gastrointestinal (GI) endoscopy for acid reflux203

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
T6700TXMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physician Group Internal Medicine CurrentSince Jul 10, 2017 Accepting new patients
Cardiovascular Care Providers, Inc. Past Accepting new patients

Locations

4201 Saint Antoine St
Ste 2E
Detroit, MI 48201
Phone (313) 265-7525

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

4201 Saint Antoine St
Ste 5C
Detroit, MI 48201
Phone (313) 577-5030

1560 E Maple Rd
Ste 400
Troy, MI 48083

Organizations & group practices 3

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 6

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": "1396742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1245658202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E MAPLE RD STE 400",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831135",
            "telephone_number": "313-745-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 SAINT ANTOINE ST STE 5C",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012153",
            "telephone_number": "313-577-5030",
            "fax_number": "313-745-4707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4201 Saint Antoine St",
            "address_2": "Suite 2E",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482012153",
            "country_code": "US",
            "telephone_number": "313-745-4525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUTLEDGE",
        "first_name": "BRIAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-06",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301105717",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TX",
            "license": "T6700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.