David Samuel Rudolph, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

OS014560 Issued in PA

Practice address

354 Newnan Crossing Byp
Suite 205
Newnan, GA 30265-2323

Phone

(678) 326-4812

NPI assigned

Apr 2, 2009

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 5

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Gastroenterology

Education

Philadelphia College of Osteopathic Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Digestive Healthcare of GeorgiaGroup PAC ID 7012904394, 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Fayette Hospital Hospital, Fayetteville, GA, CCN 110215
• Piedmont Newnan Hospital, Inc Hospital, Newnan, GA, CCN 110229
• Piedmont Henry Hospital Hospital, Stockbridge, GA, CCN 110191

Merit-based Incentive Payment System (MIPS)

Final score

91.62 of 100Reported as apm

Quality

83.25

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Digestive Healthcare of Ga, P.C.

  • Gastroenterology Physician
  • Atlanta, GA
  • NPI 1558365247
  Medicare reassignment Care Compare group NPD
• Progressive Anesthesia LLC

  • Anesthesiology Physician
  • Fayetteville, GA
  • NPI 1215225560
  NPD (past)

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

• Fayette Community Hospital, Inc.

  • General Acute Care Hospital
  • Fayetteville, GA
  • NPI 1528027240
  Care Compare affiliation
• Piedmont Henry Hospital, Inc.

  • General Acute Care Hospital
  • Stockbridge, GA
  • NPI 1225034333
  Care Compare affiliation
• Piedmont Newnan Hospital, Inc.

  • General Acute Care Hospital
  • Newnan, GA
  • NPI 1134133002
  Care Compare affiliation

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

{
    "created_epoch": "1238630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413158400000",
    "number": "1881836013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 COLLIER RD NW",
            "address_2": "SUITE 4075",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091796",
            "telephone_number": "404-355-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 NEWNAN CROSSING BYP",
            "address_2": "SUITE 205",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652323",
            "telephone_number": "678-326-4812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "DAVID",
        "middle_name": "SAMUEL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-02",
        "last_updated": "2014-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS014560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA MEDICAL LICENSE #",
            "identifier": "OS14560",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MLHC GROUP NPI #",
            "identifier": "1922077643",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MLHC MEDICARE  AA#",
            "identifier": "440771",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS AA#",
            "identifier": "824305",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MLHC GROUP AA #",
            "identifier": "037276",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Oluwatoyin Rotimi, DNP, APRN, PMHNP-BC
• David Rowan
• Conchetta Michelle Royster
• Kelsey Rudd, M.O.T. R/L
• Sheree Ann Rudder, PTA
• Vanessa Danyelle Elizabeth Ruiz
• Yoshio Walter Ruiz, MSW
• Ruki & LT LLC
• Yvonne Marie Russ, LPC, CMAC
• Laura J Russell, LLPC

• Internal Medicine Physician in Newnan, GA
• Providers in Newnan, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; 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.