James Raymond Rudolph, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

01031169A Issued in IN

Practice address

2121 Lake Ave
Fort Wayne, IN 46805-5100

Phone

(260) 426-5531

NPI assigned

Jul 17, 2006

Last updated

Apr 15, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wabash County Auditor

  dba Wabash County Health Department

  • Public Health or Welfare Agency
  • Wabash, IN
  • NPI 1225229685
  NPD (past) Authorized official
• Emergency Medicine of Indiana

  • Emergency Medicine Physician
  • Fort Wayne, IN
  • NPI 1952356883
  NPD (past)
• Grant County Auditor

  dba Grant County EMS

  • Land Ambulance
  • Gas City, IN
  • NPI 1376598078
  NPD (past)
• Honeywell Emergency Physicians

  • Emergency Medicine Physician
  • Wabash, IN
  • NPI 1770741522
  NPD (past)
• Northern Indiana Emergency Physicians, LLP

  • Emergency Medicine Physician
  • Bloomington, IN
  • NPI 1497185797
  NPD (past)
• Northern Indiana Emergency Physicians, LLP

  • Emergency Medicine Physician
  • Wabash, IN
  • NPI 1700801479
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365984000000",
    "number": "1306863923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 S DEER PARK DR",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469707279",
            "telephone_number": "765-472-7629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055100",
            "telephone_number": "260-426-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "JAMES",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2013-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01031169A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100366510",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100366510A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James S Ruckel, DC
• Ruckman Oral Surgery & Implant Center
• Phil Noble Ruckman III, D.D.S.
• Melea Ann Rudig
• Michael Rudoff, D.O.
• Rhys Rudolph, M.D.
• Thomas M Ruediger, PT
• Sandra L Ruen, MSW
• Joel A Ruetz, PA-C
• Sarita Ruetz, P.A.-C

• Emergency Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Emergency Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.