Active NPI
Matthew Mark Rueckert, ATC
- Athletic Trainer
- Fayette, IA
National Provider Identifier
1891811261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 00375
- Practice address
- 605 Washington St
Fayette, IA 52142-9206 - Phone
- (563) 425-5364
- Fax
- (563) 425-5334
- NPI assigned
- Mar 21, 2007
- Last updated
- Jul 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 00375 | IA | Primary |
Addresses
Primary practice location
605 Washington St
Fayette, IA 52142-9206
Mailing address
701 Jefferson St
West Union, IA 52175-9553
Phone (563) 422-6057
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00375 | IA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891811261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 JEFFERSON ST",
"city": "WEST UNION",
"state": "IA",
"postal_code": "521759553",
"telephone_number": "563-422-6057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "605 WASHINGTON ST",
"city": "FAYETTE",
"state": "IA",
"postal_code": "521429206",
"telephone_number": "563-425-5364",
"fax_number": "563-425-5334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUECKERT",
"first_name": "MATTHEW",
"middle_name": "MARK",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IA",
"license": "00375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayette, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.