Active NPI
Connor Rudnicki, DO
- Anesthesiology Physician
- Philadelphia, PA
National Provider Identifier
1548904329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- OS025640
- Practice address
- 5501 Old York Rd
Philadelphia, PA 19141-3018 - Phone
- (215) 456-7979
- Fax
- (215) 456-8539
- NPI assigned
- Apr 26, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | OS025640 | PA | Primary |
Addresses
Primary practice location
5501 Old York Rd
Philadelphia, PA 19141-3018
Mailing address
PO Box 788735
Philadelphia, PA 19178-8735
Phone (215) 456-7000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1046352330008 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA, NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Anesthesiology
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
435 Hurffville Cross Keys Rd
Turnersville, NJ 08012-2453
Phone (833) 958-2198
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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.
-
dba Jefferson Community Physicians of New Jersey
- Cardiovascular Disease Physician
- Robbinsville, NJ
- NPI 1649636754
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1548904329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 788735",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191788735",
"telephone_number": "215-456-7000",
"fax_number": "215-254-3289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5501 OLD YORK RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191413018",
"telephone_number": "215-456-7979",
"fax_number": "215-456-8539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDNICKI",
"first_name": "CONNOR",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-26",
"last_updated": "2026-07-13",
"certification_date": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "PA",
"license": "OS025640",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1046352330008",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.