Jeremy Ruckstaetter, PHD, LPC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2011033777 Issued in MO

Practice address

1023 Executive Parkway Dr Ste 10
Saint Louis, MO 63141-6323

Phone

(314) 469-5522

NPI assigned

Jun 12, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 4, 2025 through Dec 4, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Crossroads Christian Counseling

  • Professional Counselor
  • Saint Louis, MO
  • NPI 1477728400
  NPD (past)

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

{
    "created_epoch": "1591920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591920000000",
    "number": "1851916043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15638 SUMMER LAKE DR",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630175136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 EXECUTIVE PARKWAY DR STE 10",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416323",
            "telephone_number": "314-469-5522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCKSTAETTER",
        "first_name": "JEREMY",
        "name_prefix": "Dr.",
        "credential": "PHD, LPC, NCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-12",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2011033777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina M Ruby-Ziegler, MD
• Michelle Rene' Ruby, SLP
• Meredith Lynn Ruck, MS, ATC
• Michael A. Ruck, ACSW, LCSW
• Maricarolyn Rucker
• Mary Rudd, PT
• Katherine Grace Ruddell
• Bonnie Marie Rudden, L.P.C.
• James P Rudden, MSW, LCSW
• William John Rudder

• Professional Counselor in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.