Individual provider Active NPI

Michael T Rucker, DNP, CRNA

  • Certified Registered Nurse Anesthetist
  • Jacksonville, FL
National Provider Identifier
1588017495
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APRN11024227 Issued in FL
Practice address
2080 Child St Dept 5000
Jacksonville, FL 32214-2111
Phone
(904) 542-7632
NPI assigned
Jul 15, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X APRN11024227 FL Primary

Addresses

Primary practice location

2080 Child St Dept 5000
Jacksonville, FL 32214-2111

Mailing address

113 E Berkswell Dr
Saint Johns, FL 32259-7207
Phone (606) 224-5864

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171024001302 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 8123394962 Reassigns benefits to 2 organizations
I20230912000015 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8123394962 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sunshine State Anesthesia Partners LLCGroup PAC ID 8123434792, 429 clinicians

Practice addresses (Care Compare)

2001 Kingsley Ave
Orange Park, FL 32073-5148
Phone (904) 276-8500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.8 of 100Reported as group
Quality
99.47
Improvement activities
40
Cost
83.62

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
APRN11024227FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
SMG Anesthesia Specialists LLC CurrentSince May 10, 2021 Accepting new patients
Bon Secours Medical Group Hampton Roads Specialty Care LLC CurrentSince Jan 1, 2020 Accepting new patients
Sunshine State Anesthesia Partners LLC CurrentSince May 6, 2024 Accepting new patients
US Anesthesia Partners of Florida Inc. Nurse Anesthetist, Certified Registered CurrentSince Aug 24, 2023 Accepting new patients
Bon Secours Medical Group Hampton Roads Specialty Care LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2020 Accepting new patients

Locations

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

14000 Fivay Rd
Hudson, FL 34667
Phone (727) 819-2929

800 Prudential Dr
Jacksonville, FL 32207
Phone (904) 202-2000

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

4016 Sun City Center Blvd
Sun City Ctr, FL 33573
Phone (813) 634-0145

1000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3333

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

150 Kingsley Ln
Norfolk, VA 23505
Phone (757) 464-6944

3636 High St
Portsmouth, VA 23707
Phone (757) 398-2200

8580 Magellan Pkwy
Richmond, VA 23227
Phone (804) 627-5462

2800 Godwin Blvd
Suffolk, VA 23434
Phone (757) 363-6850

2025 Glenn Mitchell Dr
Virginia Beach, VA 23456
Phone (757) 507-1000

Organizations & group practices 5

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1588017495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 E BERKSWELL DR",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322597207",
            "telephone_number": "606-224-5864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST DEPT 5000",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322142111",
            "telephone_number": "904-542-7632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCKER",
        "first_name": "MICHAEL",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DNP, CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-15",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "APRN11024227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.