NPIMap

Individual provider Active NPI

Andrea Christine Rudolph, RN, MSN, ACNP

  • Acute Care Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1811109986
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
13834 Issued in CA
Practice address
100 UCLA Medical PLZ
Suite 760
Los Angeles, CA 90095-0001
Phone
(310) 264-7246
Fax
(310) 882-7005
NPI assigned
May 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 13834 CA Primary

Addresses

Primary practice location

100 UCLA Medical PLZ
Suite 760
Los Angeles, CA 90095-0001

Mailing address

11663 Gorham Ave
Apt. #8
Los Angeles, CA 90049-4749
Phone (310) 207-6989

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151102002865 CA Practitioner - Nurse Practitioner 8527127752 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Memorial Health SystemGroup PAC ID 9537155676, 187 clinicians

Practice addresses (Care Compare)

120 N Ashwood Ave
Ventura, CA 93003-1810
Phone (805) 658-5800

Hospital & facility affiliations

  • Community Memorial Hospital - Ventura Hospital, Ventura, CA, CCN 050394

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
13834CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Health System CurrentSince Jun 1, 2022 Accepting new patients
County of Ventura Current Accepting new patients
Community Memorial Health System Current Accepting new patients
County of Ventura CurrentSince Sep 30, 2015 Accepting new patients
Community Memorial Health System CurrentSince Jun 1, 2022 Accepting new patients

Locations

422 Arneill Rd
Ste B
Camarillo, CA 93010
Phone (805) 383-4510

2921 Saviers Rd
Oxnard, CA 93033
Phone (805) 487-5588

3291 Loma Vista Rd
Ventura, CA 93003
Phone (805) 652-6000

120 N Ashwood Ave
Ventura, CA 93003
Phone (805) 658-5800

800 S Victoria Ave
#L4640
Ventura, CA 93009

5855 Olivas Park Dr
Ventura, CA 93003
Phone (805) 652-5469

138 W Main St
Ste E
Ventura, CA 93001
Phone (805) 667-2850

147 N Brent St
Ventura, CA 93003
Phone (805) 652-5011

300 Hillmont Ave
Ventura, CA 93003
Phone (805) 652-6000

Interoperability endpoints

  • Direct secure messaging: andrearudolph@cfh.allscriptsdirect.net
  • Direct secure messaging: arudolph3518456@oc.providencedirect.org

Organizations & group practices 5

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811109986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11663 GORHAM AVE",
            "address_2": "APT. #8",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900494749",
            "telephone_number": "310-207-6989",
            "fax_number": "310-882-7005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 UCLA MEDICAL PLZ",
            "address_2": "SUITE 760",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900950001",
            "telephone_number": "310-264-7246",
            "fax_number": "310-882-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "ANDREA",
        "middle_name": "CHRISTINE",
        "name_prefix": "Ms.",
        "credential": "RN, MSN, ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "13834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.