Michiel Brent Rudder, FNP MSW

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

RN131561 Issued in TN

Practice address

622 West Market Street
Bolivar, TN 38008

Phone

(731) 658-4500

Fax

(731) 658-4545

NPI assigned

Oct 3, 2005

Last updated

Mar 7, 2023By 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 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physicians Quality Care PLLCGroup PAC ID 4385728518, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medical Center Home Health LLC Home health agency, Jackson, TN, CCN 447101
• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002
• West Tennessee Healthcare Milan Hospital Hospital, Milan, TN, CCN 440060

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Physicians Quality Care PLLC

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1528240256
  Medicare reassignment Care Compare group
• Christian Family Medicine, LLC

  dba Christian Family Medicine and Pediatrics

  • Family Medicine Physician
  • Ripley, TN
  • NPI 1043252620
  NPD
• Physicians Quality Care PLLC

  • Rural Health Clinic/Center
  • Milan, TN
  • NPI 1821906173
  NPD (past)

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

• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428
  Care Compare affiliation
• Medical Center Home Health, LLC

  • Home Health Agency
  • Jackson, TN
  • NPI 1932355997
  Care Compare affiliation
• Milan General Hospital, Inc.

  dba West Tennessee Healthcare Milan Hospital

  • General Acute Care Hospital
  • Milan, TN
  • NPI 1699765453
  Care Compare affiliation

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1841287109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11567",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383080126",
            "telephone_number": "731-661-0086",
            "fax_number": "731-661-9702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 WEST MARKET STREET",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "38008",
            "telephone_number": "731-658-4500",
            "fax_number": "731-658-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDER",
        "first_name": "MICHIEL",
        "middle_name": "BRENT",
        "credential": "FNP MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "RN131561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3909409",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Verrie Robertson
• Milicent Robinson, FNP-C
• Amanda Rogers
• Mary Ross
• Yolanda Celeste Roszell, P.T.A.
• Todd E Rutland, M.D.
• Karen Salvaggio, NP
• Debra Dianne Savage, RN
• Shanna Shackelford, DNP-APRN
• Shirleys LLC

• Family Medicine Physician in Bolivar, TN
• Providers in Bolivar, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.