Individual provider Active NPI

Pedro Ruiz

  • Student in an Organized Health Care Education/Training Program
  • Indianapolis, IN
National Provider Identifier
1790210698
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
11023814A Issued in IN
Practice address
545 Barnhill Dr Ste 232
Indianapolis, IN 46202-5112
Phone
(317) 278-0394
NPI assigned
Apr 27, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 11023814A IN Primary
General Practice Physician 208D00000X 36044 PR

Addresses

Primary practice location

545 Barnhill Dr Ste 232
Indianapolis, IN 46202-5112

Mailing address

545 Barnhill Dr Ste 232
Indianapolis, IN 46202-5112
Phone (317) 278-0394

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20240620003106 IN Order and Referring Only - Plastic and Reconstructive SurgeryPractitioner - Plastic and Reconstructive Surgery 4385187129

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36044PRMDGeneral Practice Physician
11023814AINMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1790210698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 BARNHILL DR STE 232",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025112",
            "telephone_number": "317-278-0394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 BARNHILL DR STE 232",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025112",
            "telephone_number": "317-278-0394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUIZ",
        "first_name": "PEDRO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-27",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "11023814A",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "36044",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.