Individual provider Active NPI

Cassandra Jolene Rusche, PA-C

  • Physician Assistant
  • Craig, CO
National Provider Identifier
1619216330
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0003787 Issued in CO
Practice address
750 Hospital Loop
Craig, CO 81625-8750
Phone
(970) 826-2486
Fax
(970) 826-2488
NPI assigned
Feb 1, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110004139 VA
Physician Assistant 363A00000X PA.0003787 CO Primary

Addresses

Primary practice location

750 Hospital Loop
Craig, CO 81625-8750

Mailing address

750 Hospital Loop
Craig, CO 81625-8750
Phone (970) 826-2486

Other identifiers 1

IdentifierTypeStateIssuer
10236732MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140523002014 CO Practitioner - Physician Assistant 1951546647 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.0003787COMDPhysician Assistant
0110004139VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Memorial Hospital CurrentSince Jan 1, 2024 Accepting new patients
The Memorial Hospital CurrentSince Jan 1, 2024 Accepting new patients

Locations

750 Hospital Loop
Craig, CO 81625
Phone (970) 824-9411

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": "1359676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1619216330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 HOSPITAL LOOP",
            "city": "CRAIG",
            "state": "CO",
            "postal_code": "816258750",
            "telephone_number": "970-826-2486",
            "fax_number": "970-826-2488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 HOSPITAL LOOP",
            "city": "CRAIG",
            "state": "CO",
            "postal_code": "816258750",
            "telephone_number": "970-826-2486",
            "fax_number": "970-826-2488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSCHE",
        "first_name": "CASSANDRA",
        "middle_name": "JOLENE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-01",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110004139",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0003787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10236732",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Craig, CO

Sources for this page

Verify at the official NPI Registry.