Rachel E Krackov, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9104539 Issued in FL

Practice address

15400 Biscayne Blvd
Suite 103
Aventura, FL 33160-4614

Phone

(305) 957-7277

Fax

(305) 957-7048

NPI assigned

Dec 1, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Rachel E Rudd Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Imaging Network of Rhode Island, Inc.

  • Diagnostic Radiology Physician
  • Providence, RI
  • NPI 1689657249
  NPD (past)

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312934400000",
    "number": "1922082148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15400 BISCAYNE BLVD",
            "address_2": "SUITE 103",
            "city": "AVENTURA",
            "state": "FL",
            "postal_code": "331604614",
            "telephone_number": "305-957-7277",
            "fax_number": "305-957-7048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15400 BISCAYNE BLVD",
            "address_2": "SUITE 103",
            "city": "AVENTURA",
            "state": "FL",
            "postal_code": "331604614",
            "telephone_number": "305-957-7277",
            "fax_number": "305-957-7048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRACKOV",
        "first_name": "RACHEL",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-01",
        "last_updated": "2011-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA00273",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9104539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7050011",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RACHEL",
            "last_name": "RUDD",
            "middle_name": "E",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David H Kornbluth, DMD
• Luana Kosciuczyk, DPM
• David Kosoy
• Kameswara Rao Kottapalli, MD
• Oleg Georgievich Kovalenko, M.D.
• Helena Krajewski, D.D.S
• Randee-Sue Kramer
• Tessa E Krantz, M.D.
• Warren Mitchell Krantz, M.D.
• Alexander Ian Krawiecki, MD

• Physician Assistant in Aventura, FL
• Providers in Aventura, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.