NPIMap

Individual provider Active NPI

Adam R Rudolph, MD

  • Family Medicine Physician
  • Petersburg, IN
National Provider Identifier
1821593369
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01086361A Issued in IN
Practice address
1004 E Illinois St
Petersburg, IN 47567-8068
Phone
(812) 354-1052
Fax
(812) 354-8280
NPI assigned
Mar 27, 2018
Last updated
Sep 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 01086361A IN Primary

Addresses

Primary practice location

1004 E Illinois St
Petersburg, IN 47567-8068

Mailing address

PO Box 1510
Evansville, IN 47706-1510
Phone (812) 450-6815

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20210813002949 IN Practitioner - Family Practice 2264843234 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Clinic IncGroup PAC ID 3375610116, 411 clinicians

Practice addresses (Care Compare)

1004 E Illinois St
Petersburg, IN 47567-8068
Phone (812) 354-1052

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Clinic Inc Family Medicine CurrentSince Sep 1, 2021 Accepting new patients
Deaconess Clinic Inc. Current Accepting new patients
Deaconess Clinic, Inc Family Medicine CurrentSince Sep 1, 2021 Accepting new patients

Locations

421 Chestnut St
Evansville, IN 47713
Phone (812) 426-6645

1204 Williams St
Oakland City, IN 47660
Phone (812) 749-6187

1004 E Illinois St
Petersburg, IN 47567
Phone (812) 354-1052

Interoperability endpoints

  • Direct secure messaging: arudolph227546@direct.deaconess.com

Organizations & group practices 3

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1821593369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477061510",
            "telephone_number": "812-450-6815",
            "fax_number": "812-450-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 E ILLINOIS ST",
            "city": "PETERSBURG",
            "state": "IN",
            "postal_code": "475678068",
            "telephone_number": "812-354-1052",
            "fax_number": "812-354-8280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "ADAM",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-27",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01086361A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, IN

Sources for this page

Verify at the official NPI Registry.