Individual provider Active NPI

Ruth Ellen Hetland, M.D.

  • Surgery Physician
  • Rochester, NY
National Provider Identifier
1457318966
Registry record updated Dec 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
149798 Issued in NY
Practice address
2235 Clinton Ave S
Rochester, NY 14618-2623
Phone
(585) 454-6720
Fax
(585) 454-7328
NPI assigned
Apr 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 149798 NY Primary

Addresses

Primary practice location

2235 Clinton Ave S
Rochester, NY 14618-2623

Mailing address

2235 Clinton Ave S
Rochester, NY 14618-2623
Phone (585) 454-6720

Other identifiers 1

IdentifierTypeStateIssuer
00718956MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355788800000",
    "number": "1457318966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2235 CLINTON AVE S",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146182623",
            "telephone_number": "585-454-6720",
            "fax_number": "585-454-7328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 CLINTON AVE S",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146182623",
            "telephone_number": "585-454-6720",
            "fax_number": "585-454-7328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETLAND",
        "first_name": "RUTH",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2012-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "149798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00718956",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; 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.