Active NPI
Heather Ruddock, MD
- Pediatrics Physician
- Philadelphia, PA
National Provider Identifier
1780631846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA08898000
- Practice address
- 2000 Hamilton St Ste 301
Philadelphia, PA 19130-3874 - Phone
- (215) 774-1166
- Fax
- (215) 279-8383
- NPI assigned
- May 27, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD056728 | PA | |
| Pediatrics Physician | 208000000X | 25MA08898000 | NJ | Primary |
Addresses
Primary practice location
2000 Hamilton St Ste 301
Philadelphia, PA 19130-3874
Mailing address
401 Route 73 N
BLDG 10, Suite 320
Marlton, NJ 08053
Phone (215) 774-1166
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01670460 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA, NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD056728 | PA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advocare, LLC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- heather.ruddock@advocaredoctors.eclinicaldirectplus.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.
-
- Pediatrics Physician
- Cherry Hill, NJ
- NPI 1780696732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679875200000",
"number": "1780631846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 ROUTE 73 N",
"address_2": "BLDG 10, SUITE 320",
"city": "MARLTON",
"state": "NJ",
"postal_code": "08053",
"telephone_number": "215-774-1166",
"fax_number": "215-279-8383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 HAMILTON ST STE 301",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191303874",
"telephone_number": "215-774-1166",
"fax_number": "215-279-8383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDDOCK",
"first_name": "HEATHER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-27",
"last_updated": "2023-03-27",
"certification_date": "2023-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD056728",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA08898000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01670460",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.