Individual provider Active NPI

Thomas J Rufledt, DDS

  • Dentist
  • Bloomer, WI
National Provider Identifier
1487859336
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5001844 Issued in WI
Practice address
1502 Main St
Bloomer, WI 54724-1686
Phone
(715) 568-2363
Fax
(715) 568-2373
NPI assigned
Jun 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 5001844 WI Primary

Addresses

Primary practice location

1502 Main St
Bloomer, WI 54724-1686

Mailing address

1502 Main St
Bloomer, WI 54724-1686
Phone (715) 568-2363

Other identifiers 1

IdentifierTypeStateIssuer
33350400MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150605000464 WI Order and Referring Only - DentistPractitioner - Dentist 4789905514

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Diamond Family Dental SC Dentist Past Accepting new patients

Organizations & group practices 1

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": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487859336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 MAIN ST",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "547241686",
            "telephone_number": "715-568-2363",
            "fax_number": "715-568-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 MAIN ST",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "547241686",
            "telephone_number": "715-568-2363",
            "fax_number": "715-568-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUFLEDT",
        "first_name": "THOMAS",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "5001844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33350400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomer, WI

Sources for this page

Verify at the official NPI Registry.