Individual provider Active NPI

Nori Y Ruo, MD

  • Pediatrics Physician
  • Douglas, AZ
National Provider Identifier
1710922018
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD059349L Issued in PA
Practice address
815 E 15TH St
Douglas, AZ 85607-1631
Phone
(520) 364-5437
Fax
(520) 364-4261
NPI assigned
Jun 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD059349L PA Primary

Addresses

Primary practice location

815 E 15TH St
Douglas, AZ 85607-1631

Mailing address

1205 F Ave
Douglas, AZ 85607-1920
Phone (520) 364-1429

Other identifiers 1

IdentifierTypeStateIssuer
001606226MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20150812008395 AZ Practitioner - Pediatric Medicine 7113232604 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD059349LPAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chiricahua Community Health Centers, Inc. CurrentSince Jun 15, 2015 Accepting new patients
Chiricahua Community Health Centers, Inc CurrentSince Jun 15, 2015 Accepting new patients

Locations

335 S Ocotillo St
Benson, AZ 85602
Phone (520) 326-4811

108 Arizona St
Bisbee, AZ 85603
Phone (520) 432-3309

1111 N F Ave
Douglas, AZ 85607
Phone (520) 364-6860

1100 N F Ave
Douglas, AZ 85607
Phone (520) 364-3285

1205 N F Ave
Douglas, AZ 85607
Phone (520) 364-6852

1151 E 16th St
Douglas, AZ 85607
Phone (520) 364-5437

815 E 15th St
Douglas, AZ 85607
Phone (520) 364-5437

10566 N Highway 191
Elfrida, AZ 85610
Phone (520) 642-2222

4755 Campus Dr
Sierra Vista, AZ 85635
Phone (520) 226-3020

155 Calle Portal
Ste 700
Sierra Vista, AZ 85635
Phone (520) 459-0203

4525 Campus Dr
Sierra Vista, AZ 85635
Phone (520) 459-5959

155 Calle Portal
Ste 300
Sierra Vista, AZ 85635
Phone (520) 458-6331

251 W Rex Allen Dr
Willcox, AZ 85643

Interoperability endpoints

  • Direct secure messaging: nori.ruo.p1@direct.cchci.nextgenshare.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1710922018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 F AVE",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "856071920",
            "telephone_number": "520-364-1429",
            "fax_number": "520-364-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 E 15TH ST",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "856071631",
            "telephone_number": "520-364-5437",
            "fax_number": "520-364-4261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUO",
        "first_name": "NORI",
        "middle_name": "Y",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD059349L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001606226",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglas, AZ

Sources for this page

Verify at the official NPI Registry.