Active NPI
Peter Mitchell Ruderman, M.S.W.
- Psychoanalyst
- Saint Louis, MO
National Provider Identifier
1457584138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychoanalyst
- License
- 000742
- Practice address
- 8820 Ladue Rd
Saint Louis, MO 63124-2079 - Phone
- (314) 754-3253
- NPI assigned
- Aug 28, 2009
- Last updated
- Aug 28, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | 000742 | MO | Primary |
Addresses
Primary practice location
8820 Ladue Rd
Saint Louis, MO 63124-2079
Mailing address
8820 Ladue Road
St. Louis, MO 63124
Phone (314) 754-3253
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000742 | MO | MD | Psychoanalyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251417600000",
"number": "1457584138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8820 LADUE ROAD",
"city": "ST. LOUIS",
"state": "MO",
"postal_code": "63124",
"telephone_number": "314-754-3253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8820 LADUE RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631242079",
"telephone_number": "314-754-3253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDERMAN",
"first_name": "PETER",
"middle_name": "MITCHELL",
"name_prefix": "Mr.",
"credential": "M.S.W.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-08-28",
"last_updated": "2009-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": "MO",
"license": "000742",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.