Douglas Brent Rutan, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

P0515 Issued in WA

Practice address

100 E 33Rd St Ste 206
Vancouver, WA 98663-2776

Phone

(360) 695-1334

Fax

(360) 992-1159

NPI assigned

Aug 26, 2005

Last updated

Jun 29, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clover Podiatry PLLCGroup PAC ID 2466870118, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clover Podiatry PLLC

  • Foot & Ankle Surgery Podiatrist
  • Camas, WA
  • NPI 1912525288
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1821081613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E 33RD ST STE 206",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986632776",
            "telephone_number": "360-695-1334",
            "fax_number": "360-992-1159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 33RD ST STE 206",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986632776",
            "telephone_number": "360-695-1334",
            "fax_number": "360-992-1159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTAN",
        "first_name": "DOUGLAS",
        "middle_name": "BRENT",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WA",
            "license": "P0515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMARA",
            "identifier": "164425100000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "480014538",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2047640",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "050259000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Serena Lynn Russum, ND
• Cuchulain Luke Rust, M.D.
• Trista Rust
• Rachel April Renee Rustad, BS, MS
• Kamila D Rustamova, RN
• Miriam Christina Ruth, MD
• Kelly Dee Rutherford, M.D.
• Krystal Nicole Rutherford
• Sherri L. Rutherford, DO
• Jennifer Ruthhardt

• Podiatrist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Podiatrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.