Active NPI
Douglas Rudisill
- Emergency Medicine Physician
- Moses Lake, WA
National Provider Identifier
1871578740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- MD60041375
- Practice address
- 801 E Wheeler Rd
Moses Lake, WA 98837-1820 - Phone
- (509) 765-5606
- Fax
- (253) 838-6418
- NPI assigned
- Dec 13, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Emergency Response Attendant | 146D00000X | C42852 | CA | |
| Emergency Medicine Physician | 207P00000X | MD60041375 | WA | Primary |
Addresses
Primary practice location
801 E Wheeler Rd
Moses Lake, WA 98837-1820
Mailing address
505 S 336TH St
Suite 600
Federal Way, WA 98003-5947
Phone (253) 838-6180
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9111RU | Other | WA | BSWA |
| 0243670 | Other | WA | LIWA |
| 0243670 | Other | WA | VCR |
| 8531188 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Physician Associates, Apc | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Federal Way, WA
- NPI 1407127442
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282089600000",
"number": "1871578740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 S 336TH ST",
"address_2": "SUITE 600",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980035947",
"telephone_number": "253-838-6180",
"fax_number": "253-838-6418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 E WHEELER RD",
"city": "MOSES LAKE",
"state": "WA",
"postal_code": "988371820",
"telephone_number": "509-765-5606",
"fax_number": "253-838-6418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDISILL",
"first_name": "DOUGLAS",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-13",
"last_updated": "2010-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "146D00000X",
"taxonomy_group": "",
"desc": "Personal Emergency Response Attendant",
"state": "CA",
"license": "C42852",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "WA",
"license": "MD60041375",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BSWA",
"identifier": "9111RU",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LIWA",
"identifier": "0243670",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VCR",
"identifier": "0243670",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8531188",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moses Lake, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.