Individual provider Active NPI

Adam J Ruskowski

  • Pediatrics Physician
  • Pembroke Pines, FL
National Provider Identifier
1487974747
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
OS9823 Issued in FL
Practice address
400 N Hiatus Rd Ste 105
Pembroke Pines, FL 33026-5214
Phone
(954) 431-8000
NPI assigned
Jun 9, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X UO2435 FL
Pediatrics Physician 208000000X OS9823 FL Primary

Addresses

Primary practice location

400 N Hiatus Rd Ste 105
Pembroke Pines, FL 33026-5214

Mailing address

3763 Millenia Blvd Apt 303
Orlando, FL 32839-6469
Phone (740) 590-6572

Other practice location 1

5900 S John Young Pkwy
Orlando, FL 32839-3716
Phone (407) 398-6470 ext. 209

Other identifiers 2

IdentifierTypeStateIssuer
009464400MedicaidFL
OS12322OtherFLOS12322

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130326000349 FL Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 3577708411

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS9823FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saltzman, Tanis, Pittell, Levin and Jacobson Pediatrics PastSince Jun 16, 2024 Accepting new patients
Saltzman, Tanis, Pittell, Levin and Jacobson, LLC Pediatrics PastSince Jun 16, 2024 Accepting new patients

Organizations & group practices 2

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": "1276041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1487974747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3763 MILLENIA BLVD APT 303",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328396469",
            "telephone_number": "740-590-6572",
            "fax_number": "740-590-6572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N HIATUS RD STE 105",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330265214",
            "telephone_number": "954-431-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5900 S John Young Pkwy",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328393716",
            "country_code": "US",
            "telephone_number": "407-398-6470 x209",
            "fax_number": "407-894-6872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSKOWSKI",
        "first_name": "ADAM",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-09",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "UO2435",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS9823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009464400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OS12322",
            "identifier": "OS12322",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.