Organization Active NPI

Glenn a Ruhl, DPM, PC

  • Foot & Ankle Surgery Podiatrist
  • Woburn, MA
National Provider Identifier
1447317623
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
1642 Issued in MA
Legal business name
GLENN A RUHL, DPM, PC
Practice address
479 Main St
Woburn, MA 01801-7000
Phone
(781) 935-3828
Fax
(781) 932-3252
NPI assigned
Jan 3, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Glenn A Ruhl, DPMNPI 1639175714
Title
President
Phone
(781) 935-3828

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 1642 MA Primary

Addresses

Primary practice location

479 Main St
Woburn, MA 01801-7000

Mailing address

479 Main St
Woburn, MA 01801-7000
Phone (781) 935-3828

Other identifiers 1

IdentifierTypeStateIssuer
Y77113OtherMABLUECROSS GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060405000390 MA Part B Supplier - Clinic/Group Practice 1456369222 Receives reassigned benefits from 1 practitioner
Practice locations: Woburn, MA

National Provider Directory

National Provider Directory

Locations

479 Main St
Woburn, MA 01801
Phone (617) 935-3828

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447317623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "479 MAIN ST",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018017000",
            "telephone_number": "781-935-3828",
            "fax_number": "781-932-3252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "479 MAIN ST",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018017000",
            "telephone_number": "781-935-3828",
            "fax_number": "781-932-3252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN A RUHL, DPM, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUHL",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-935-3828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MA",
            "license": "1642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS GROUP",
            "identifier": "Y77113",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.