NPIMap

Individual provider Active NPI

Walter Rucker, MD

  • Family Medicine Physician
  • Cleveland, TN
National Provider Identifier
1386644094
Registry record updated Oct 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
28924 Issued in TN
Practice address
2535 Georgetown Rd NW
Cleveland, TN 37311-3534
Phone
(423) 389-8000
Fax
(615) 216-8538
NPI assigned
Jul 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 28924 TN Primary

Addresses

Primary practice location

2535 Georgetown Rd NW
Cleveland, TN 37311-3534

Mailing address

2535 Georgetown Rd NW
Cleveland, TN 37311-3534
Phone (423) 389-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20071204000841 TN Practitioner - Family PracticePractitioner - Geriatric Medicine 2163511742 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
University of Kentucky College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comprehensive Wellness Center LLCGroup PAC ID 9133387012, 4 clinicians
At Home Primary Care IncGroup PAC ID 8325236953, 11 clinicians

Practice addresses (Care Compare)

2535 Georgetown Rd NW
Cleveland, TN 37311-3534
Phone (423) 389-8000

463 1St St NW
Cleveland, TN 37311-1760
Phone (423) 790-7662

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
At Home Primary Care Inc CurrentSince Nov 3, 2010 Accepting new patients
Comprehensive Wellness Center LLC Family Medicine CurrentSince Jan 2, 2012 Accepting new patients
Cleveland Medical Clinic Inc Family Medicine Past Accepting new patients
Athens Physicians Practice LLC Family Medicine Past Accepting new patients

Locations

463 1st St NW
Cleveland, TN 37311
Phone (423) 790-6556

2535 Georgetown Rd NW
Cleveland, TN 37311
Phone (423) 244-0311

Organizations & group practices 4

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349308800000",
    "number": "1386644094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2535 GEORGETOWN RD NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113534",
            "telephone_number": "423-389-8000",
            "fax_number": "615-216-8538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2535 GEORGETOWN RD NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113534",
            "telephone_number": "423-389-8000",
            "fax_number": "615-216-8538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCKER",
        "first_name": "WALTER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-22",
        "last_updated": "2012-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "28924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, TN

Sources for this page

Verify at the official NPI Registry.