Active NPI
Petr O Ruzicka, M.D.
- Pediatric Surgery Physician
- Mesa, AZ
National Provider Identifier
1689611832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Surgery Physician
- License
- 41004
- Practice address
- 1432 S, Dobson
Suite 403
Mesa, AZ 85202 - Phone
- (480) 412-7400
- Fax
- (480) 412-7500
- NPI assigned
- May 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Legal Medicine | 173000000X | |||
| Pediatric Surgery Physician | 2086S0120X | 41004 | AZ | Primary |
Addresses
Primary practice location
1432 S, Dobson
Suite 403
Mesa, AZ 85202
Mailing address
1432 S, Dobson
Suite 403
Mesa, AZ 85202
Phone (480) 412-7400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Surgical Specialty Group, Inc | Pediatric Surgery | Past | Accepting new patients |
| Institute of Neurology and Neurosurgery at Saint Barnabas | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/2f26dc99-c358-4b2b-a63e-0bdfec0a9b98/
Organizations & group practices 2
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.
-
- Pediatric Surgery Physician
- Norfolk, VA
- NPI 1245248947
-
- Neurology Physician
- Livingston, NJ
- NPI 1386656270
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301443200000",
"number": "1689611832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1432 S, DOBSON",
"address_2": "SUITE 403",
"city": "MESA",
"state": "AZ",
"postal_code": "85202",
"telephone_number": "480-412-7400",
"fax_number": "480-412-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1432 S, DOBSON",
"address_2": "SUITE 403",
"city": "MESA",
"state": "AZ",
"postal_code": "85202",
"telephone_number": "480-412-7400",
"fax_number": "480-412-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUZICKA",
"first_name": "PETR",
"middle_name": "O",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-31",
"last_updated": "2011-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "173000000X",
"taxonomy_group": "",
"desc": "Legal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "AZ",
"license": "41004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.