Active NPI
David Scott Rudolph, MD
- Internal Medicine Physician
- Palmer, AK
National Provider Identifier
1376526749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 2066
- Practice address
- 561 S Denali
Ste C
Palmer, AK 99645 - Phone
- (907) 745-8432
- Fax
- (907) 746-4489
- NPI assigned
- Nov 21, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 2066 | AK | Primary |
Addresses
Primary practice location
561 S Denali
Ste C
Palmer, AK 99645
Mailing address
561 S Denali
Ste C
Palmer, AK 99645
Phone (907) 745-8432
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD2033 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mat-Su Valley Medical Center LLC | Past | Accepting new patients | |
| David Rudolph, MD | Internal Medicine | Past | Accepting new patients |
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.
-
- General Acute Care Hospital
- Palmer, AK
- NPI 1417975061
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192579200000",
"number": "1376526749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "561 S DENALI",
"address_2": "STE C",
"city": "PALMER",
"state": "AK",
"postal_code": "99645",
"telephone_number": "907-745-8432",
"fax_number": "907-746-4489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "561 S DENALI",
"address_2": "STE C",
"city": "PALMER",
"state": "AK",
"postal_code": "99645",
"telephone_number": "907-745-8432",
"fax_number": "907-746-4489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDOLPH",
"first_name": "DAVID",
"middle_name": "SCOTT",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-21",
"last_updated": "2007-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AK",
"license": "2066",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MD2033",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palmer, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.