Individual provider Active NPI

Delbert C Rudy, MD

  • Urology Physician
  • Stephenville, TX
National Provider Identifier
1386630481
Registry record updated Aug 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
G9524 Issued in TX
Practice address
150 River North Blvd
Stephenville, TX 76401-1803
Phone
(254) 968-6051
Fax
(254) 968-4950
NPI assigned
Sep 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X G9524 TX Primary

Addresses

Primary practice location

150 River North Blvd
Stephenville, TX 76401-1803

Mailing address

150 River North Blvd
Stephenville, TX 76401-1803
Phone (254) 968-6051

Other identifiers 1

IdentifierTypeStateIssuer
137746716MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20190305001365 IL Practitioner - Urology 9931247723 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G9524TXMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois CurrentSince Feb 11, 2019 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Pekin Prohealth Inc Urology CurrentSince Feb 11, 2019 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Feb 11, 2019 Accepting new patients
Medical Clinic of North Texas PLLC Past Accepting new patients
Urology Associates of North Texas LLP Urology Past Accepting new patients

Locations

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

815 Main St
Ste A1
Peoria, IL 61602

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 6

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": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440547200000",
    "number": "1386630481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 RIVER NORTH BLVD",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764011803",
            "telephone_number": "254-968-6051",
            "fax_number": "254-968-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 RIVER NORTH BLVD",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764011803",
            "telephone_number": "254-968-6051",
            "fax_number": "254-968-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDY",
        "first_name": "DELBERT",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2015-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "TX",
            "license": "G9524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137746716",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stephenville, TX

Sources for this page

Verify at the official NPI Registry.