Joseph Rudolph, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MOR4E01 Issued in MO

Practice address

1011 Bowles Ave
Suite 300
Fenton, MO 63026-2395

Phone

(314) 496-5000

Fax

(314) 496-5015

NPI assigned

Jul 17, 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• SSM Medical Group

  • Family Medicine Physician
  • Fenton, MO
  • NPI 1275781288
  NPD (past)
• SSM Medical Group

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1316953656
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251849600000",
    "number": "1376561464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10777 SUNSET OFFICE DR",
            "address_2": "SUITE 310",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271019",
            "telephone_number": "314-822-5900",
            "fax_number": "314-822-5919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE",
            "address_2": "SUITE 300",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262395",
            "telephone_number": "314-496-5000",
            "fax_number": "314-496-5015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2009-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "MOR4E01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202083069",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amelia Roseberry
• Stacey Ann Rosenbaum, PT
• Mark W Roshell, MS PT
• Carley Michele Roth
• Round Two Investments, Inc
• Sara K Rumpel, PHARMD
• Miriam A Rusert, R.PH.
• Brittany Ryan, RN
• Samantha April Saale, PMHNP
• Saferoute Nemt, LLC

• Pediatrics Physician in Fenton, MO
• Providers in Fenton, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.