NPIMap

Individual provider Active NPI

Theresa Wendel Ruddy, M.D.

  • Colon & Rectal Surgery Physician
  • Liverpool, NY
National Provider Identifier
1841491099
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
18258-875 Issued in WI
Practice address
5100 W Taft Rd Ste 4a
Liverpool, NY 13088-3810
Phone
(315) 458-2211
Fax
(315) 452-9025
NPI assigned
May 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Trauma Surgery Physician 2086S0127X 255925 NY
Surgery Physician 208600000X 255925 NY
Colon & Rectal Surgery Physician 208C00000X 18258-875 WI Primary
Colon & Rectal Surgery Physician 208C00000X 255925 NY

Addresses

Primary practice location

5100 W Taft Rd Ste 4a
Liverpool, NY 13088-3810

Mailing address

5100 W Taft Rd Ste 4a
Liverpool, NY 13088-3810
Phone (315) 458-2211

Other identifiers 1

IdentifierTypeStateIssuer
03280522MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, WI, VT3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20110103000866 NY Practitioner - Colorectal Surgery (Proctology)Practitioner - General Surgery 4082704572 Reassigns benefits to 1 organization
I20180629000029 WI Practitioner - General SurgeryPractitioner - Colorectal Surgery (Proctology) 4082704572 Reassigns benefits to 1 organization
I20180904003312 VT Practitioner - General Surgery 4082704572 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)
Education
State University of New York at Buffalo School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oneida Surgical Group PCGroup PAC ID 3779527718, 4 clinicians

Practice addresses (Care Compare)

357 Genesee St
Suite 3
Oneida, NY 13421-2658
Phone (315) 363-8800

Hospital & facility affiliations

  • Rome Memorial Hospital, Inc Hospital, Rome, NY, CCN 330215
  • Oneida Health Hospital Hospital, Oneida, NY, CCN 330115

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy132
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux54
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
255925NYMDTrauma Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Current Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Jun 1, 2018 Accepting new patients
Oneida Surgical Group PC Surgery CurrentSince Sep 1, 2018 Accepting new patients
Porter Hospital, Inc Surgery CurrentSince Aug 1, 2018 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Jun 1, 2018 Accepting new patients
Rome Memorial Hospital, Inc. Past Accepting new patients
Fairbanks Memorial Physician Specialities Past Accepting new patients

Locations

357 Genesee St
Ste 3
Oneida, NY 13421
Phone (315) 363-8800

104 Porter Dr
Middlebury, VT 05753
Phone (802) 388-5682

82 Catamount Park
Middlebury, VT 05753
Phone (802) 388-7185

116 Porter Dr
Middlebury, VT 05753
Phone (802) 388-6326

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

Organizations & group practices 7

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 9

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": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528675200000",
    "number": "1841491099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD STE 4A",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883810",
            "telephone_number": "315-458-2211",
            "fax_number": "315-452-9025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD STE 4A",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883810",
            "telephone_number": "315-458-2211",
            "fax_number": "315-452-9025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDY",
        "first_name": "THERESA",
        "middle_name": "WENDEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-29",
        "last_updated": "2018-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "NY",
            "license": "255925",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "255925",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "WI",
            "license": "18258-875",
            "primary": true
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "NY",
            "license": "255925",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03280522",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.