Active NPI
Raymond Rudolph, MD
- Surgery Physician
- Savannah, GA
National Provider Identifier
1295836617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 30205
- Practice address
- 4700 Waters Ave
Suite 405
Savannah, GA 31404-6220 - Phone
- (912) 350-2700
- Fax
- (912) 350-2715
- NPI assigned
- Sep 26, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 30205 | GA | Primary |
| Surgery Physician | 208600000X | 21641 | SC |
Addresses
Primary practice location
4700 Waters Ave
Suite 405
Savannah, GA 31404-6220
Mailing address
4700 Waters Ave
Suite 405
Savannah, GA 31404-6220
Phone (912) 350-2700
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000453043L | Medicaid | GA | |
| 10065386 | Other | GA | AMERIGROUP |
| 000453043E | Medicaid | GA | |
| P00955061 | Other | SC | RAILROAD MEDICARE |
| 000453043I | Medicaid | GA | |
| 000453043M | Medicaid | GA | |
| 020047969 | Other | GA | RAILROAD MEDICARE |
| 020050906 | Other | SC | RAILROAD MEDICARE |
| 349825 | Other | GA | WELLCARE |
| 000453043B | Medicaid | GA | |
| 000453043D | Medicaid | GA | |
| 000453043G | Medicaid | GA | |
| P00955071 | Other | GA | RAILROAD MEDICARE |
| 000453043J | Medicaid | GA | |
| G30205 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30205 | GA | MD | Surgery Physician |
| 21641 | SC | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MPPG, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366934400000",
"number": "1295836617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 WATERS AVE",
"address_2": "SUITE 405",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314046220",
"telephone_number": "912-350-2700",
"fax_number": "912-350-2715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 WATERS AVE",
"address_2": "SUITE 405",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314046220",
"telephone_number": "912-350-2700",
"fax_number": "912-350-2715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDOLPH",
"first_name": "RAYMOND",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2013-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "GA",
"license": "30205",
"primary": true
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "SC",
"license": "21641",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000453043L",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "10065386",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000453043E",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00955061",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000453043I",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000453043M",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "020047969",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "020050906",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "349825",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000453043B",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000453043D",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000453043G",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00955071",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000453043J",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "G30205",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2013; 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.