Active NPI
Paul Geoffrey Rutledge, MD
- Family Medicine Physician
- Saint Louis, MO
National Provider Identifier
1497763783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2003023209
- Practice address
- 12812 Tesson Ferry Rd
Saint Louis, MO 63128-2913 - Phone
- (314) 722-2862
- Fax
- (314) 722-2852
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 036-113309 | IL | |
| Family Medicine Physician | 207Q00000X | 036-113309 | IL | |
| Family Medicine Physician | 207Q00000X | 2003023209 | MO | Primary |
Addresses
Primary practice location
12812 Tesson Ferry Rd
Saint Louis, MO 63128-2913
Mailing address
PO Box 23340
Saint Louis, MO 63156-3340
Phone (314) 722-2862
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08232205 | Other | IL | BLUE CROSS BLUE SHIELD |
| 209084607 | Medicaid | MO | |
| 0008232163 | Other | IL | BLUECROSS BLUESHIELD |
| 036113309 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Saint Louis University School of Medicine, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
13303 Tesson Ferry Rd
Saint Louis, MO 63128-4062
1475 Kisker Rd
Suite 230
Saint Charles, MO 63304-8791
Phone (636) 939-5000
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-113309 | IL | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Emergency Management, Inc. | Emergency Medicine | Past | Accepting new patients |
| Physician Groups LC | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- paulgeoffrey.rutledge.p1@direct.essehealth.nextgenshare.com
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.
-
- Internal Medicine Physician
- Saint Louis, MO
- NPI 1972559532
-
- Urgent Care Clinic/Center
- O Fallon, IL
- NPI 1487601506
Emergency Medicine
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Festus, MO
- NPI 1508859661
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1568481984
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1427098169
-
- General Acute Care Hospital
- Fenton, MO
- NPI 1851496152
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424304000000",
"number": "1497763783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 23340",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631563340",
"telephone_number": "314-722-2862",
"fax_number": "314-722-2852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12812 TESSON FERRY RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631282913",
"telephone_number": "314-722-2862",
"fax_number": "314-722-2852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUTLEDGE",
"first_name": "PAUL",
"middle_name": "GEOFFREY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2015-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IL",
"license": "036-113309",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036-113309",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "2003023209",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "08232205",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209084607",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "0008232163",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036113309",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; 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.