Individual provider Active NPI

Richard B Rudolph, MD

  • Gynecology Physician
  • Clearwater, FL
National Provider Identifier
1366430654
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
ME0073548 Issued in FL
Practice address
508 Jeffords St
Suite C
Clearwater, FL 33756-3839
Phone
(727) 461-2757
Fax
(727) 447-0314
NPI assigned
Oct 11, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X ME0073548 FL
Gynecology Physician 207VG0400X ME0073548 FL Primary

Addresses

Primary practice location

508 Jeffords St
Suite C
Clearwater, FL 33756-3839

Mailing address

PO Box 748817
Atlanta, GA 30374-8817
Phone (813) 286-0033

Other identifiers 1

IdentifierTypeStateIssuer
023702300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20040721000051 FL Practitioner - Obstetrics/Gynecology 7517947617 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of South Florida College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Womens Care Florida LLCGroup PAC ID 9234031444, 324 clinicians

Practice addresses (Care Compare)

508 Jeffords St
Suite C
Clearwater, FL 33756-3839
Phone (727) 461-2757

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0073548FLMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Women'S Care Florida LLC Obstetrics & Gynecology CurrentSince Jan 1, 1998 Accepting new patients
Womens' Health Hospitalists, LLC Obstetrics & Gynecology CurrentSince Jun 27, 2018 Accepting new patients

Locations

508 Jeffords St
Ste C
Clearwater, FL 33756
Phone (727) 461-2757

4150 Woodlands Pkwy
Ste A
Palm Harbor, FL 34685
Phone (727) 461-2757

900 Carillon Pkwy
Ste 302
St Petersburg, FL 33716
Phone (727) 456-0145

2818 W Virginia Ave
Tampa, FL 33607
Phone (813) 872-8551

5002 W Lemon St
Tampa, FL 33609

4030 W Boy Scout Blvd
Ste 800
Tampa, FL 33607
Phone (813) 286-0333

Organizations & group practices 2

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": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1366430654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748817",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303748817",
            "telephone_number": "813-286-0033",
            "fax_number": "813-282-1806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 JEFFORDS ST",
            "address_2": "SUITE C",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337563839",
            "telephone_number": "727-461-2757",
            "fax_number": "727-447-0314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "RICHARD",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME0073548",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "FL",
            "license": "ME0073548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023702300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.