Nicholas Adam Rudloff, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2014025262 Issued in MO

Practice address

1805 NW Platte Rd Ste 120
Riverside, MO 64150-7500

Phone

(816) 472-0400

NPI assigned

Sep 26, 2008

Last updated

Feb 18, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Dermatology

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Epiphany Dermatology of Missouri LLCGroup PAC ID 1153689294, 21 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

88.84 of 100Reported as group

Quality

80.25

Promoting interoperability

100

Improvement activities

40

Cost

82.55

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nrudloff@epiphanykc.emadirect.md

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.

• Epiphany Dermatology of Missouri, LLC

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1528573342

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1222387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1407006364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 NW PLATTE RD STE 120",
            "city": "RIVERSIDE",
            "state": "MO",
            "postal_code": "641507500",
            "telephone_number": "816-472-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 NW PLATTE RD STE 120",
            "city": "RIVERSIDE",
            "state": "MO",
            "postal_code": "641507500",
            "telephone_number": "816-472-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDLOFF",
        "first_name": "NICHOLAS",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-26",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2014025262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Riverside Nursing and Rehabilitation Center LLC
• Riverside Pharmacy Associates, LLC
• Riverside Pharmacy Associates, LLC (Apex Specialty Pharmacy)
• Abigail Hardy Rives, LCSW
• Josie Deeanna Ross, PHARM.D.
• Stacey Jo Russell, PTA
• Sage Behavioral Health and Wellness LLC
• Shelby Jennings Sailor, PTA
• Serc Rehabilitation Partners, LLC (Serc)
• Andrew Carl Shore

• Dermatology Physician in Riverside, MO
• Providers in Riverside, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.