Russell M Rudy, MD – Emergency Medicine Physician

Key facts

NPI: 1790766988
Entity type: Individual (NPI type 1)
Primary specialty: Emergency Medicine Physician 207P00000X
License: 35049204 (OH)
Practice address: 401 N Ewing St
Lancaster, OH 43130-3372
Phone: (740) 687-8000
Fax: (740) 687-8939
NPI assigned: Nov 7, 2005
Sex: Male
Sole proprietor: No

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.

Fairfield Emergency Physicians Inc Emergency Medicine Physician · Lancaster, OH · NPI 1598705949

NPD (past) EMERGENCY MEDICINE
Fairfield ER Physicians Dba Fairfield Medical Center Pro Fee Emergency Medicine Physician · Lancaster, OH · NPI 1942233879

NPD (past) EMERGENCY MEDICINE

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
35049204	OH	MD	Emergency Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
Fairfield Emergency Physicians Inc	Emergency Medicine	Past	Accepting new patients
Fairfield ER Physicians Dba Fairfield Medical Center Pro Fee	Emergency Medicine	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Emergency Medicine Physician	207P00000X	35049204	OH	Yes

Addresses

Primary practice location

401 N Ewing St
Lancaster, OH 43130-3372

Mailing address

PO Box 713464
Cincinnati, OH 45271-0001
Phone (740) 687-8990

Other identifiers

Identifier	Type	State	Issuer
35049204	Other	OH	OHIO STATE LICENSE NO
0683532	Medicaid	OH

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 31, 2011.

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306800000000",
    "number": "1790766988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713464",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452710001",
            "telephone_number": "740-687-8990",
            "fax_number": "740-687-8230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N EWING ST",
            "city": "LANCASTER",
            "state": "OH",
            "postal_code": "431303372",
            "telephone_number": "740-687-8000",
            "fax_number": "740-687-8939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDY",
        "first_name": "RUSSELL",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2011-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35049204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO STATE LICENSE NO",
            "identifier": "35049204",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0683532",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, OH

All providers in Lancaster, OH · Emergency Medicine Physician in Ohio

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.