Lisa Rudolph, DNP, AGNP-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F307978-1 Issued in NY

Practice address

55 Water St FL 46
New York, NY 10041-3211

Phone

(212) 649-5555

NPI assigned

Oct 21, 2016

Sex

Female

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 NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

State University of New York at Buffalo School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Trustees of Columbia University in the City of New YorkGroup PAC ID 8527972546, 2,262 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as apm

Quality

85.32

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678

Interoperability endpoints

• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• Trustees of Columbia University in the City of New York

  • Surgery Physician
  • New York, NY
  • NPI 1508266347
  Medicare reassignment Care Compare group NPD
• MJHS Medical Associates

  • Internal Medicine Physician
  • New York, NY
  • NPI 1013208602
  Medicare reassignment NPD
• Trustees of Columbia University in the City of New York

  • Anesthesiology Physician
  • New York, NY
  • NPI 1477068971
  NPD
• Trustees of Columbia University in the City of New York

  • Internal Medicine Physician
  • New York, NY
  • NPI 1699289488
  NPD

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

{
    "created_epoch": "1477008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1487105714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 HYATT AVE",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107044314",
            "telephone_number": "716-697-8342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WATER ST FL 46",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100413211",
            "telephone_number": "212-649-5555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "444 Norwood Ave",
            "address_2": "Apt 2",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142221560",
            "country_code": "US",
            "telephone_number": "716-697-8342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "LISA",
        "credential": "DNP, AGNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-21",
        "last_updated": "2024-07-02",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F307978-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Carol Rudolph, MD
• Iris Marie Rudolph
• Jeffrey Alan Rudolph
• Joanna Carol Rudolph, L M S W
• Leslie Ann Rudolph, RPAC
• Shentique Monique Rudolph
• Ann Rudovsky, L.C.S.W.
• Eric Matthew Rudow
• Sally Hechinger Rudoy, MSW, LCSW
• Michelle Rudshteyn Korostin, MD

• Adult Health Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; 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.