NPIMap

Individual provider Active NPI

Earl H Rudolph, D.O.

  • Internal Medicine Physician
  • Marion, IL
National Provider Identifier
1487851481
Registry record updated May 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036.134994 Issued in IL
Practice address
3333 W Deyoung St
Marion, IL 62959-5884
Phone
(618) 998-7017
Fax
(618) 998-7449
NPI assigned
Jul 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036.134994 IL Primary

Addresses

Primary practice location

3333 W Deyoung St
Marion, IL 62959-5884

Mailing address

6004 Flagg Creek LN
Western Springs, IL 60558-5034
Phone (630) 201-4239

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150113002515 IL Practitioner - Internal Medicine 2466641618 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
RML Health Providers Limited PartnershipGroup PAC ID 2961459565, 11 clinicians

Practice addresses (Care Compare)

5601 S County Line Rd
Hinsdale, IL 60521-4875
Phone (630) 286-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.134994ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Physicians of Illinois, LLC Internal Medicine CurrentSince Jul 3, 2020 Accepting new patients
RML Health Providers Limited Partnership CurrentSince Jun 1, 2023 Accepting new patients
Miinedoctor, Inc. Internal Medicine CurrentSince Mar 1, 2022 Accepting new patients
River to River Heart Group, LLC Internal Medicine Past Accepting new patients

Locations

3435 W Van Buren St
Chicago, IL 60624
Phone (773) 265-7700

3316 Payshere Cir
Chicago, IL 60674

1044 N Francisco Ave
Chicago, IL 60622
Phone (773) 292-8227

5601 S County Line Rd
Hinsdale, IL 60521
Phone (630) 286-4000

8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500

Interoperability endpoints

  • Direct secure messaging: erudolph@yourcarecommunity.org

Organizations & group practices 5

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558656000000",
    "number": "1487851481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6004 FLAGG CREEK LN",
            "city": "WESTERN SPRINGS",
            "state": "IL",
            "postal_code": "605585034",
            "telephone_number": "630-201-4239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 W DEYOUNG ST",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595884",
            "telephone_number": "618-998-7017",
            "fax_number": "618-998-7449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "EARL",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-02",
        "last_updated": "2019-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.134994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IL

Sources for this page

Verify at the official NPI Registry.