Individual provider Active NPI

Paul G Rudkin, AUDIOLOGIST

  • Audiologist
  • Janesville, WI
National Provider Identifier
1467640078
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
135-156 Issued in WI
Practice address
3524 E Milwaukee St
Janesville, WI 53546-1626
Phone
(608) 756-7100
NPI assigned
Oct 9, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 135-156 WI Primary

Addresses

Primary practice location

3524 E Milwaukee St
Janesville, WI 53546-1626

Mailing address

3524 E Milwaukee St
Janesville, WI 53546-1626
Phone (608) 756-7100

Other identifiers 1

IdentifierTypeStateIssuer
41127400MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100610000682 WI Practitioner - Qualified Audiologist 9739219189 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation Current Accepting new patients
Mercy Health System Corporation CurrentSince Nov 10, 1997 Accepting new patients
Mercy Health System Corporation CurrentSince Nov 10, 1997 Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

3524 E Milwaukee St
Janesville, WI 53546
Phone (608) 756-7100

N2950 State Road 67
Lake Geneva, WI 53147
Phone (262) 245-0535

Interoperability endpoints

  • Direct secure messaging: prudkin3899@direct.mhemail.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1467640078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3524 E MILWAUKEE ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535461626",
            "telephone_number": "608-756-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3524 E MILWAUKEE ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535461626",
            "telephone_number": "608-756-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDKIN",
        "first_name": "PAUL",
        "middle_name": "G",
        "credential": "AUDIOLOGIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-09",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WI",
            "license": "135-156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41127400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.