Individual provider Active NPI

Hollie C. Rudolph, PA-C

  • Physician Assistant
  • Newark, DE
National Provider Identifier
1720538630
Registry record updated Dec 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C5-0001093 Issued in DE
Practice address
4701 Ogletown Stanton Road
Suite 2100
Newark, DE 19713-7000
Phone
(302) 623-4530
Fax
(302) 623-4578
NPI assigned
Oct 4, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C5-0001093 DE Primary
Physician Assistant 363A00000X DE

Addresses

Primary practice location

4701 Ogletown Stanton Road
Suite 2100
Newark, DE 19713-7000

Mailing address

200 Hygeia Dr Ste 2300
CCHS Physician Contracting
Newark, DE 19713-2049

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170124003107 DE Practitioner - Physician Assistant 3971885013 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

4745 Ogletown Stanton Rd
Newark, DE 19713-2074
Phone (302) 623-7600

4755 Ogletown Stanton Rd
Newark, DE 19718-2200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C5-0001093DEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services Inc CurrentSince Dec 4, 2016 Accepting new patients
Christiana Care Health Services Inc CurrentSince Dec 4, 2016 Accepting new patients
Christiana Care Health Services Inc. Past Accepting new patients

Locations

4701 Ogletown Stanton Rd
Ste 2100
Newark, DE 19713
Phone (302) 623-4530

4755 Ogletown Stanton Rd
Ste 2E70
Newark, DE 19718
Phone (302) 733-3475

4745 Stanton Ogletwn Rd
Newark, DE 19713
Phone (302) 623-7600

200 Hygeia Dr
Ste 2300
Newark, DE 19713
Phone (302) 623-7362

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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": "1475539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482278400000",
    "number": "1720538630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HYGEIA DR STE 2300",
            "address_2": "CCHS PHYSICIAN CONTRACTING",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197132049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 OGLETOWN STANTON ROAD",
            "address_2": "SUITE 2100",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197137000",
            "telephone_number": "302-623-4530",
            "fax_number": "302-623-4578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "HOLLIE",
        "middle_name": "C.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-04",
        "last_updated": "2016-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0001093",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.