Paetra Jane Ruddy, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD61231855 Issued in WA

Practice address

19917 7TH Ave NE Ste 203
Poulsbo, WA 98370-6555

Phone

(360) 824-5474

Fax

(360) 994-4975

NPI assigned

Jun 22, 2011

Sex

Female

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 WA

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

Specialty

Dermatology

Education

University of Iowa, RJ & L Carver College of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Silver Falls Dermatology LLCGroup PAC ID 5890863492, 100 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Michael Medical Center Hospital, Silverdale, WA, CCN 500039

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Silver Falls Dermatology, LLC

  • Dermatology Physician
  • Salem, OR
  • NPI 1134375421

  WA

  Medicare reassignment Care Compare group NPD
• Silver Falls Dermatology, LLC

  • Ambulatory Surgical Clinic/Center
  • Seattle, WA
  • NPI 1417163635
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Commonspirit Washington Community Care

  • General Acute Care Hospital
  • Silverdale, WA
  • NPI 1518912609
  Care Compare affiliation

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1366738874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1793 13TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022541",
            "telephone_number": "503-362-8385",
            "fax_number": "503-362-8435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19917 7TH AVE NE STE 203",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706555",
            "telephone_number": "360-824-5474",
            "fax_number": "360-994-4975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDY",
        "first_name": "PAETRA",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-22",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2015026116",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "MD61231855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200024055",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "522 N New Ballas Rd",
            "address_2": "Div IM Dermatology, Ste 316",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631416857",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristi Rosanski
• Harry E Ross, ARNP
• Paula M Rovik, LMHC
• Rowphysio Physical Therapy
• Kara C Rubens
• Danielle Suzanne Rueb, LMHCA
• James Rutledge, PA-C
• Alyssa Ryan
• James Thomas Ryan, D.C.
• Safeway Inc

• Dermatology Physician in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.