Renee N Rutherford, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-003107 Issued in IL

Practice address

916 Talon Dr
Suite 102
O Fallon, IL 62269-1848

Phone

(618) 628-8211

Fax

(618) 628-0883

NPI assigned

Oct 18, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219276800000",
    "number": "1619166345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 TALON DR",
            "address_2": "SUITE 102",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691848",
            "telephone_number": "618-628-8211",
            "fax_number": "618-628-0883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 TALON DR",
            "address_2": "SUITE 102",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691848",
            "telephone_number": "618-628-8211",
            "fax_number": "618-628-0883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTHERFORD",
        "first_name": "RENEE",
        "middle_name": "N",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-18",
        "last_updated": "2008-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-003107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parker Roustio, DMD
• Scott R. Roustio, MD
• Stephanie Roxby, LCSW
• Andrea M Russell, MS, CCC-SLP
• Laine Russell
• Abbey Saba
• Gabriella Labrizi Sabatino, DC
• Rachel Salazar, LCSW
• Sarah Danielle Miller Salzman
• Rema Sanghavi, D.O.

• Physician Assistant in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.