Individual provider Active NPI

Sheila R Ruschmeyer, MD

  • Pediatrics Physician
  • Mankato, MN
National Provider Identifier
1750360772
Registry record updated Jul 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
39422 Issued in MN
Practice address
1230 E Main St
Mankato Clinic at Main Street
Mankato, MN 56001-5066
Phone
(507) 625-1811
NPI assigned
Jan 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2020

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 39422 MN Primary

Addresses

Primary practice location

1230 E Main St
Mankato Clinic at Main Street
Mankato, MN 56001-5066

Mailing address

1230 E Main St
PO Box 8674
Mankato, MN 56001-5066
Phone (507) 625-1811

Other identifiers 9

IdentifierTypeStateIssuer
848526700MedicaidMN
0580704MedicaidIA
41084933956001C110OtherCHAMPUS
HP29361OtherMNHEALTH PARTNERS
117686OtherMNUCARE
41B80RUOtherMNBCBS
NA2951023859OtherMNPREFERRED ONE
1201494OtherMNMEDICA
1645201OtherMNAMERICAS PPO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sheilaruschmeyer@mklt.allscriptsdirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20100127000631 MN Practitioner - Pediatric Medicine 1153463294 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mankato Clinic LTD Pediatrics CurrentSince Nov 25, 2009 Accepting new patients

Locations

1230 E Main St
Mankato, MN 56001
Phone (507) 389-8502

1421 Premier Dr
Mankato, MN 56001
Phone (507) 385-4000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1750360772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 E MAIN ST",
            "address_2": "PO BOX 8674",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015066",
            "telephone_number": "507-625-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 E MAIN ST",
            "address_2": "MANKATO CLINIC AT MAIN STREET",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015066",
            "telephone_number": "507-625-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSCHMEYER",
        "first_name": "SHEILA",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-10",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "39422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "848526700",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0580704",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "41084933956001C110",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP29361",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "117686",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "41B80RU",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "NA2951023859",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "1201494",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAS PPO",
            "identifier": "1645201",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sheilaruschmeyer@mklt.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Mankato Clinic Direct ID, Allscripts Community",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1421 Premier Dr",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560016076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.