NPIMap

Individual provider Active NPI

Lance A. Rudolph, M.D.

  • Internal Medicine Physician
  • Albuquerque, NM
National Provider Identifier
1376502997
Registry record updated Jan 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
83-104 Issued in NM
Practice address
300 Oak St NE
Albuquerque, NM 87106-4725
Phone
(505) 855-5525
Fax
(505) 884-4006
NPI assigned
Mar 22, 2006
Last updated
Jan 31, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 83-104 NM Primary

Addresses

Primary practice location

300 Oak St NE
Albuquerque, NM 87106-4725

Mailing address

300 Oak St NE
Albuquerque, NM 87106-4725
Phone (505) 855-5525

Other identifiers 3

IdentifierTypeStateIssuer
000Z5691MedicaidNM
NM004414OtherNMBCBS NM/HMO NM
000-16667MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101015000233 NM Practitioner - Internal Medicine 8729271366 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Southern California Keck School of Medicine, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

300 Oak St NE
Albuquerque, NM 87106-4725
Phone (505) 855-5525

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
69.4 of 100Reported as group
Quality
35
Improvement activities
40
Cost
84.66

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
New Mexico Clinical Research & Osteoporosis Center, Inc Internal Medicine CurrentSince Oct 1, 1998 Accepting new patients
Taos Health Systems, Inc., Holy Cross Hospital Past Accepting new patients

Locations

300 Oak St NE
Albuquerque, NM 87106
Phone (505) 855-5255

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201737600000",
    "number": "1376502997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 OAK ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064725",
            "telephone_number": "505-855-5525",
            "fax_number": "505-884-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OAK ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064725",
            "telephone_number": "505-855-5525",
            "fax_number": "505-884-4006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "LANCE",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2008-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "83-104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000Z5691",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NM/HMO NM",
            "identifier": "NM004414",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000-16667",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.