NPIMap

Individual provider Active NPI

Avidah H Rudberg, M.D.

  • Urology Physician
  • Bonita Springs, FL
National Provider Identifier
1639124779
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
ME142399 Issued in FL
Practice address
9500 Bonita Beach Rd SE Ste 201
Bonita Springs, FL 34135-4683
Phone
(239) 441-2932
Fax
(239) 441-4045
NPI assigned
May 24, 2006
Last updated
Aug 1, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X ME142399 FL Primary

Addresses

Primary practice location

9500 Bonita Beach Rd SE Ste 201
Bonita Springs, FL 34135-4683

Mailing address

6321 Daniels Pkwy Ste 200
Fort Myers, FL 33912-4710
Phone (239) 416-8101

Other identifiers 1

IdentifierTypeStateIssuer
124211000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040717000068 NY Practitioner - Urology 0345229886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Rutgers, Robert Woood Johnson Medical School, 1989
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6321 Daniels Pkwy
Suite 200
Fort Myers, FL 33912-4708

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME142399FLMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maimonides Medical Center Current Accepting new patients
Precision Healthcare Specialists, LLC Urology CurrentSince Dec 2, 2024 Accepting new patients
R&N Anesthesia PLLC PastSince Jul 1, 2004 Accepting new patients
Mermaid Management Inc PastSince Jun 1, 2011 Accepting new patients

Locations

9500 Bonita Beach Rd SE
Ste 201
Bonita Springs, FL 34135
Phone (239) 319-2195

13691 Metro Pkwy
Ste 300
Fort Myers, FL 33912
Phone (239) 291-6970

6321 Daniels Pkwy
Ste 200
Fort Myers, FL 33912
Phone (855) 674-7400

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: avidahrudberg@mai.allscriptsdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1639124779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6321 DANIELS PKWY STE 200",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124710",
            "telephone_number": "239-416-8101",
            "fax_number": "239-402-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 BONITA BEACH RD SE STE 201",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354683",
            "telephone_number": "239-441-2932",
            "fax_number": "239-441-4045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDBERG",
        "first_name": "AVIDAH",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "ME142399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124211000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonita Springs, FL

Sources for this page

Verify at the official NPI Registry.