Individual provider Active NPI

Courtney Rusch

  • Pediatric Gastroenterology Physician
  • Royal Oak, MI
National Provider Identifier
1821659483
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
4301513350 Issued in MI
Practice address
110 E 2ND St
Royal Oak, MI 48067-2694
Phone
(248) 546-2110
NPI assigned
Jun 25, 2019
Last updated
Jul 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2019023134 MO
Pediatrics Physician 208000000X 01088085A IN
Pediatrics Physician 208000000X 4301513350 MI
Pediatric Gastroenterology Physician 2080P0206X 4301513350 MI Primary

Addresses

Primary practice location

110 E 2ND St
Royal Oak, MI 48067-2694

Mailing address

1 Ford PL Ste 3a
Detroit, MI 48202-3450
Phone (313) 874-4806

Other practice location 1

1 Childrens Pl # 3S34
Saint Louis, MO 63110-1002
Phone (314) 454-6006

Other practice location 2

705 Riley Hospital Drive
Roc 4210
Indianapolis, IN 46202-5109
Phone (317) 944-2078

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250617000694 MI Practitioner - Pediatric MedicinePractitioner - Gastroenterology 0143696799 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01088085AINMDPediatrics Physician
2019023134MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Current Accepting new patients
Henry Ford Health System CurrentSince Jun 1, 2025 Accepting new patients
Henry Ford Health System CurrentSince Jun 1, 2025 Accepting new patients
Major Hospital Past Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients

Locations

1 Ford Pl
Ste 3A
Detroit, MI 48202
Phone (313) 874-2892

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

110 E 2nd St
Royal Oak, MI 48067
Phone (248) 546-2110

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1821659483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FORD PL STE 3A",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023450",
            "telephone_number": "313-874-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E 2ND ST",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480672694",
            "telephone_number": "248-546-2110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Childrens Pl # 3S34",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101002",
            "country_code": "US",
            "telephone_number": "314-454-6006",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "705 Riley Hospital Drive",
            "address_2": "ROC 4210",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025109",
            "country_code": "US",
            "telephone_number": "317-944-2078",
            "fax_number": "317-968-1055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSCH",
        "first_name": "COURTNEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-25",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2019023134",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01088085A",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301513350",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "MI",
            "license": "4301513350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.