Cornelio Roderick Ruperto, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

2006-01732 Issued in NC

Practice address

6620 Shallowford Rd
Suite 200
Lewisville, NC 27023-9504

Phone

(336) 945-0345

Fax

(336) 945-0342

NPI assigned

Mar 27, 2007

Last updated

Oct 25, 2020By 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 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cruperto198389@direct.novanthealth.org

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.

• Forsyth Memorial Hospital, Inc.

  dba NH Forsyth Primary Care Clinics

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1104548874
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment NPD
• Forsyth Memorial Hospital, Inc

  dba Novant Health Psychiatric Medicine

  • Psychiatry Physician
  • Thomasville, NC
  • NPI 1003209842
  NPD
• Forsyth Memorial Hospital, Inc.

  dba Novant Health Heart & Vascular Institute - Frontis Plaza

  • Cardiovascular Disease Physician
  • Winston Salem, NC
  • NPI 1932935475
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Elizabeth OB/GYN

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Psychiatric Medicine

  • Psychiatry Physician
  • Winston Salem, NC
  • NPI 1770876914
  NPD

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1316065204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 PILOT RIDGE DR",
            "city": "LEWISVILLE",
            "state": "NC",
            "postal_code": "270238119",
            "telephone_number": "336-945-0345",
            "fax_number": "336-945-0342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6620 SHALLOWFORD RD",
            "address_2": "SUITE 200",
            "city": "LEWISVILLE",
            "state": "NC",
            "postal_code": "270239504",
            "telephone_number": "336-945-0345",
            "fax_number": "336-945-0342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUPERTO",
        "first_name": "CORNELIO",
        "middle_name": "RODERICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2006-01732",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NC",
            "license": "2006-01732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900260",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cruperto198389@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "6620 Shallowford Rd",
            "address_2": "Suite 200",
            "city": "Lewisville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "270239504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Haley Pegram Quick, LCMHC
• Reformation Counseling PLLC
• Shawn Arango Ricks, PH.D.,LCAS-A
• Hannah O'Hare Riddle, M.S., CCC-SLP
• Root & Bloom Wellness, PLLC
• Sage & Serene Counseling PLLC
• Rashmi Jyotsna Saincher, MBBS
• Salem Mobility Inc
• Elmer M Santos, BS
• Anna Conrad Sebastian

• Child & Adolescent Psychiatry Physician in Lewisville, NC
• Providers in Lewisville, NC by specialty
• Child & Adolescent Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2020; 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.

Verify at the official NPI Registry.