Active NPI
Lauren Alexandra Rutter, PH.D.
- Clinical Psychologist
- Bloomington, IN
National Provider Identifier
1790473395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20043322B
- Practice address
- 1101 E 10TH St
Bloomington, IN 47405-7007 - Phone
- (812) 856-9953
- NPI assigned
- May 1, 2023
- 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 |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 20043322B | IN | |
| Clinical Psychologist | 103TC0700X | 20043322B | IN | Primary |
Addresses
Primary practice location
1101 E 10TH St
Bloomington, IN 47405-7007
Mailing address
1101 E 10TH St
Bloomington, IN 47405-7007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 8, 2026 through Jul 8, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20043322B | IN | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682899200000",
"number": "1790473395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 E 10TH ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474057007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 E 10TH ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474057007",
"telephone_number": "812-856-9953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUTTER",
"first_name": "LAUREN",
"middle_name": "ALEXANDRA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-01",
"last_updated": "2023-05-01",
"certification_date": "2023-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "IN",
"license": "20043322B",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20043322B",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.