Charles Rudolph, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD32155 Issued in TN

Practice address

170 Mouse Creek Rd NW
Cleveland, TN 37312-3840

Phone

(423) 458-1426

Fax

(423) 790-1276

NPI assigned

Aug 31, 2006

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 7

Medicare fee-for-service enrollment

Enrolled in TN, NC, GA3 enrollments

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 3

Specialty

Family Practice

Education

Texas Tech University Health Science Center School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Afc Urgent Care and Family Care of WNC PLLCGroup PAC ID 2567713332, 75 clinicians

DX Mso of Georgia LLCGroup PAC ID 1153702931, 9 clinicians

DX Mso PLLCGroup PAC ID 7719131101, 88 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charles.rudolph.1@19840.direct.athenahealth.com

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.

• DX Mso, PLLC

  • Urgent Care Clinic/Center
  • Chattanooga, TN
  • NPI 1225381148
  Medicare reassignment Care Compare group NPD Authorized official
• Afc Urgent Care and Family Care of WNC, PLLC

  • Urgent Care Clinic/Center
  • Charlotte, NC
  • NPI 1679066658
  Medicare reassignment Care Compare group NPD Authorized official
• DX Mso of Georgia LLC

  • Multi-Specialty Clinic/Center
  • Dalton, GA
  • NPI 1922757111
  Medicare reassignment Care Compare group NPD Authorized official
• Southeastern Physician Services PC

  • Hospitalist Physician
  • Oak Ridge, TN
  • NPI 1083835441

  Internal Medicine

  NPD (past)
• Ecc Hospitalist Services PC

  • Hospitalist Physician
  • Rome, GA
  • NPI 1710108170

  Internal Medicine

  NPD (past)
• HMC Physician Billing LLC

  • Internal Medicine Physician
  • Fort Oglethorpe, GA
  • NPI 1467504167
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1346351673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 PEERLESS XING NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373123764",
            "telephone_number": "423-476-5990",
            "fax_number": "423-476-5887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 MOUSE CREEK RD NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373123840",
            "telephone_number": "423-458-1426",
            "fax_number": "423-790-1276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD32155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000931499D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3855171",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00931499A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3855172",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSEE",
            "identifier": "3148810",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4150063",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00199940",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyley Rose
• Elizabeth Underwood Rosenberger, MD
• Sharon Rotnem
• Marian Wilson Rowland, APN
• Walter Rucker, MD
• Jeffrey L Russell, PHARMD
• Ethan Brandon Rutledge, D.O.
• Heather L Ryerson, LPC/MHSP
• Nina Michelle Sadeghi, DMD
• Holly Beth Salicco, BCBA

• Internal Medicine Physician in Cleveland, TN
• Providers in Cleveland, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.