Jane Elizabeth Rudolph, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

023752 Issued in CT

Practice address

179 Roseland Ave
Waterbury, CT 06710

Phone

(203) 574-4747

Fax

(203) 574-2251

NPI assigned

Aug 9, 2006

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

Other identifiers 3

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: janerudolph@caahc-ct.direct.office.nextgen.com
• FHIR API: https://api.platform.athenahealth.com/11240/brand/1/csg/1/fhir/r4
• Direct secure messaging: jrudolph@direct.wtbyhosp.org

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.

• Child & Adolescent Health Care

  • Pediatrics Physician
  • Waterbury, CT
  • NPI 1497937411
  NPD (past) Authorized official

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1639189707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 ROSELAND AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06710",
            "telephone_number": "203-574-4747",
            "fax_number": "203-574-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 ROSELAND AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06710",
            "telephone_number": "203-574-4747",
            "fax_number": "203-574-2251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "JANE",
        "middle_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "023752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCFP",
            "identifier": "00123752800",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001237528",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HN",
            "identifier": "0K0607",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jrudolph43114@direct.stfranciscare.org",
            "affiliation": "N",
            "endpointDescription": "Trinity Health of New England Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "179 Roseland Ave",
            "city": "Waterbury",
            "state": "CT",
            "country_code": "US",
            "postal_code": "06710",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JaneRudolph@CAAHC-CT.direct.office.nextgen.com",
            "affiliation": "N",
            "endpointDescription": "Child  & Adolescent Health Care Associates direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "179 Roseland Ave",
            "city": "Waterbury",
            "state": "CT",
            "country_code": "US",
            "postal_code": "06710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Royalty Home Care LLC
• William Francis Rozmajzl Jr., D.D.S.
• Christina Rubano, PA-C
• Bernadette Ruberte, BA
• Danielle Sylvie Rudich, MD
• Emily Ruegg, PA-C
• Alexia Ruesch Modesto Alves
• Mark Louis Ruggiero, M.D.
• Jessica Ruggles
• Marc Rumilly, PA

• Pediatrics Physician in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.