NPIMap

Organization Active NPI

Daniel Rutrick, MD, PC

  • Prescribing (Medical) Psychologist
  • Everett, MA
National Provider Identifier
1336341502
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prescribing (Medical) PsychologistTaxonomy code 103TP0016X
License
36462 Issued in MA
Legal business name
DANIEL RUTRICK, MD, PC
Practice address
617 Broadway
Everett, MA 02149-3712
Phone
(617) 387-2220
Fax
(617) 394-0538
NPI assigned
Jun 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Daniel Rutrick, M.D.NPI 1568499242
Title
President
Phone
(617) 387-2220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prescribing (Medical) PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TP0016X 36462 MA Primary

Addresses

Primary practice location

617 Broadway
Everett, MA 02149-3712

Mailing address

617 Broadway
Everett, MA 02149-3712
Phone (617) 387-2220

Other identifiers 4

IdentifierTypeStateIssuer
M13835OtherMABLUE CROSS BLUE SHIELD
036462OtherMATUFTS GROUP NUMBER
500019OtherMATUFTS PSYCHOLOGIST NUMBER
500064OtherMATUFTS CERTIFIED NURSE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336341502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 BROADWAY",
            "city": "EVERETT",
            "state": "MA",
            "postal_code": "021493712",
            "telephone_number": "617-387-2220",
            "fax_number": "617-394-0538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 BROADWAY",
            "city": "EVERETT",
            "state": "MA",
            "postal_code": "021493712",
            "telephone_number": "617-387-2220",
            "fax_number": "617-394-0538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL RUTRICK, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUTRICK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-387-2220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "MA",
            "license": "36462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "M13835",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS GROUP NUMBER",
            "identifier": "036462",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS PSYCHOLOGIST NUMBER",
            "identifier": "500019",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS CERTIFIED NURSE",
            "identifier": "500064",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.