Individual provider Active NPI

Eduardo Rueda Vasquez, MD

  • Psychiatry Physician
  • Williamsport, PA
National Provider Identifier
1891730842
Registry record updated Sep 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD438359 Issued in PA
Practice address
1000 Commerce Park Dr
Suite 110
Williamsport, PA 17701-5475
Phone
(570) 323-6944
Fax
(570) 323-4529
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2013

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD438359 PA Primary
Psychiatry Physician 2084P0800X 18868 GA
Psychiatry Physician 2084P0800X 0101048597 VA
Psychiatry Physician 2084P0800X 223712 NY
Psychiatry Physician 2084P0800X 31332 FL

Addresses

Primary practice location

1000 Commerce Park Dr
Suite 110
Williamsport, PA 17701-5475

Mailing address

320 Highland Dr
P.O. Box 597
Mountville, PA 17554-1232
Phone (717) 285-7121

Other identifiers 1

IdentifierTypeStateIssuer
1028002940001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20130625000571 PA Practitioner - Psychiatry 2961532684 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Services Group IncGroup PAC ID 1052201571, 32 clinicians

Practice addresses (Care Compare)

1000 Commerce Park Dr
Suite 110
Williamsport, PA 17701-5475
Phone (570) 323-6944

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18868GAMDPsychiatry Physician
223712NYMDPsychiatry Physician
MD438359PAMDPsychiatry Physician
0101048597VAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Services Group, Inc. CurrentSince Oct 1, 2013 Accepting new patients

Locations

1902 Olde Homestead Ln
Lancaster, PA 17601
Phone (717) 285-7121

7930 Nittany Valley Dr
Mill Hall, PA 17751
Phone (570) 323-6944

320 Highland Dr
Mountville, PA 17554
Phone (717) 285-7121

1000 Commerce Park Dr
Ste 110
Williamsport, PA 17701
Phone (570) 323-6944

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.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380240000000",
    "number": "1891730842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 HIGHLAND DR",
            "address_2": "P.O. BOX 597",
            "city": "MOUNTVILLE",
            "state": "PA",
            "postal_code": "175541232",
            "telephone_number": "717-285-7121",
            "fax_number": "717-285-2658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 COMMERCE PARK DR",
            "address_2": "SUITE 110",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177015475",
            "telephone_number": "570-323-6944",
            "fax_number": "570-323-4529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUEDA VASQUEZ",
        "first_name": "EDUARDO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2013-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD438359",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "18868",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101048597",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "223712",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "31332",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1028002940001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.