Active NPI
Theodor Major Rudolph, M.D.
- Dermatology Physician
- Vero Beach, FL
National Provider Identifier
1700861382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- ME79805
- Practice address
- 3900 20TH St
Vero Beach, FL 32960-2413 - Phone
- (772) 299-4000
- Fax
- (772) 299-4001
- NPI assigned
- Dec 7, 2005
- Last updated
- Sep 14, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | ME79805 | FL | Primary |
| MOHS-Micrographic Surgery Physician | 207ND0101X | ME79805 | FL | |
| Pediatric Dermatology Physician | 207NP0225X | ME79805 | FL | |
| Procedural Dermatology Physician | 207NS0135X | ME79805 | FL |
Addresses
Primary practice location
3900 20TH St
Vero Beach, FL 32960-2413
Mailing address
3900 20TH St
Vero Beach, FL 32960-2413
Phone (772) 299-4000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 261870200 | Medicaid | FL |
Other names 1
- Ted Major Rudolph
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- University of Colorado School of Medicine, Denver, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3900 20TH St
Vero Beach, FL 32960-2413
Phone (772) 299-4000
Hospital & facility affiliations
- Activa Home Health
- Anchor Health Homecare Services, LLC
- Elite Home Health Group Inc
- Cleveland Clinic Indian River Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 32 |
| Removal of tissue | 12 |
| Removal of skin lesions | 6216 |
| Removal of skin cancer | 437 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1289 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunnycoast Dermatology, Inc. | Dermatology | Current | Accepting new patients |
Locations
1850 43rd Ave
Ste 4C
Vero Beach, FL 32960
Phone (772) 299-4000
3900 20th St
Vero Beach, FL 32960
Phone (772) 299-4000
Interoperability endpoints
- trudolph@sunderm1134.srs-direct.com
Organizations & group practices 1
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.
-
- Dermatology Physician
- Vero Beach, FL
- NPI 1962487546
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Boca Raton, FL
- NPI 1578954335
-
dba Cleveland Clinic Indian River Hospital
- General Acute Care Hospital
- Vero Beach, FL
- NPI 1376512988
-
dba Senior Care Solutions
- Home Health Agency
- Boca Raton, FL
- NPI 1609507920
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600041600000",
"number": "1700861382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3900 20TH ST",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329602413",
"telephone_number": "772-299-4000",
"fax_number": "772-299-4001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 20TH ST",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329602413",
"telephone_number": "772-299-4000",
"fax_number": "772-299-4001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDOLPH",
"first_name": "THEODOR",
"middle_name": "MAJOR",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-07",
"last_updated": "2020-09-14",
"certification_date": "2020-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "FL",
"license": "ME79805",
"primary": true
},
{
"code": "207ND0101X",
"taxonomy_group": "",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": "FL",
"license": "ME79805",
"primary": false
},
{
"code": "207NP0225X",
"taxonomy_group": "",
"desc": "Dermatology, Pediatric Dermatology",
"state": "FL",
"license": "ME79805",
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "FL",
"license": "ME79805",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "261870200",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TED",
"last_name": "RUDOLPH",
"middle_name": "MAJOR",
"credential": "M.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Vero Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.