Ralph H. Ruckle, M.D.
Individual provider Active NPI Family Medicine Physician · Portland, TN
NPI 1790770378 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1790770378
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD9576 (TN)
- Practice address
- 103 Redbud Dr
Suite C
Portland, TN 37148-1617 - Phone
- (615) 325-7337
- Fax
- (615) 325-0164
- NPI assigned
- Sep 20, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091207000136 | TN | Practitioner - Family Practice | 3274672142 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD9576 | TN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sumner Physician Practices, LLC | Current |
Accepting new patients | |
| Sumner Physician Practices LLC | Family Medicine | Current |
Accepting new patients |
| Sumner Physician Practices LLC | Current | Accepting new patients |
Locations
225 Big Station Camp Blvd
Ste 211
Gallatin, TN 37066
Phone (615) 328-3480
700 S Broadway St
Portland, TN 37148
Phone (615) 325-3100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD9576 | TN | Yes |
Addresses
Primary practice location
103 Redbud Dr
Suite C
Portland, TN 37148-1617
Mailing address
103 Redbud Dr
Suite C
Portland, TN 37148-1617
Phone (615) 325-7337
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2000371 | Other | TN | BCBS OF TENNESSEE |
Other providers in Portland, TN
- Red Spruce Emergency Physicians, PLLC
- Andrea Reed
- Justin Tyler Reid
- Results-Ast JV, LLC
- Richland Place Senior Living
- Tasha Ruffin
- Pepito Salcedo
- Salient Emergency Physicians, PLLC
- Christine Sexton
- Paige Sexton
All providers in Portland, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.