Individual provider Active NPI

John Daniel Ruck

  • Family Nurse Practitioner
  • Lynchburg, VA
National Provider Identifier
1336688456
Registry record updated Jul 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024174478 Issued in VA
Practice address
125 Nationwide Dr
Lynchburg, VA 24502-4272
Phone
(434) 200-3908
NPI assigned
Feb 22, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024174478 VA Primary

Addresses

Primary practice location

125 Nationwide Dr
Lynchburg, VA 24502-4272

Mailing address

2010 Atherholt Rd
Lynchburg, VA 24501-1106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, MA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200710000174 AL Practitioner - Nurse Practitioner 8527335694 Reassigns benefits to 1 organization
I20220912000084 MA Practitioner - Nurse Practitioner 8527335694 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024174478VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Aug 1, 2022 Accepting new patients
The Florence Endocrine Clinic a Professional Limited Liability Company CurrentSince Aug 1, 2020 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Aug 1, 2022 Accepting new patients
Joslin Clinic Inc CurrentSince Aug 1, 2022 Accepting new patients

Locations

145 Ana Dr
Florence, AL 35630
Phone (256) 284-7280

1 Joslin Pl
Boston, MA 02215
Phone (617) 309-2400

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500422400000",
    "number": "1336688456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 ATHERHOLT RD",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245011106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 NATIONWIDE DR",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245024272",
            "telephone_number": "434-200-3908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCK",
        "first_name": "JOHN",
        "middle_name": "DANIEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-22",
        "last_updated": "2017-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024174478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynchburg, VA

Sources for this page

Verify at the official NPI Registry.