Individual provider Active NPI

David L. Rudler, L.I.S.W.

  • Clinical Social Worker
  • Conneaut, OH
National Provider Identifier
1528052743
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I-0009314 Issued in OH
Practice address
852 Grove St
Conneaut, OH 44030-1658
Phone
(440) 599-9074
Fax
(440) 599-9074
NPI assigned
Sep 2, 2005
Sex
Male
Sole proprietor
Yes

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
Clinical Social Worker 1041C0700X I-0009314 OH Primary

Addresses

Primary practice location

852 Grove St
Conneaut, OH 44030-1658

Mailing address

852 Grove St
Conneaut, OH 44030-1658
Phone (440) 599-9074

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240206001944 OH Practitioner - Clinical Social Worker 0840267225 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I-0009314OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Health, Inc. Current Accepting new patients
Signature Health Inc CurrentSince Dec 23, 2023 Accepting new patients
Signature Health, Inc CurrentSince Dec 23, 2023 Accepting new patients

Locations

21100 Southgate Park Blvd
Maple Heights, OH 44137
Phone (216) 663-6100

7232 Justin Way
Mentor, OH 44060
Phone (440) 488-2855

38876 Mentor Ave
Willoughby, OH 44094
Phone (440) 954-3333

38882 Mentor Ave
Willoughby, OH 44094

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.

NPI Registry JSON

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528052743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "852 GROVE ST",
            "city": "CONNEAUT",
            "state": "OH",
            "postal_code": "440301658",
            "telephone_number": "440-599-9074",
            "fax_number": "440-599-9074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "852 GROVE ST",
            "city": "CONNEAUT",
            "state": "OH",
            "postal_code": "440301658",
            "telephone_number": "440-599-9074",
            "fax_number": "440-599-9074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDLER",
        "first_name": "DAVID",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "credential": "L.I.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I-0009314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conneaut, OH

Sources for this page

Verify at the official NPI Registry.