Active NPI
Lo'Rell Rudolph, DO
- Pediatrics Physician
- Dearborn, MI
National Provider Identifier
1922427160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 5101021994
- Practice address
- 5500 Auto Club Dr
Dearborn, MI 48126 - Phone
- (313) 425-4500
- NPI assigned
- Apr 15, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5101021994 | MI | Primary |
Addresses
Primary practice location
5500 Auto Club Dr
Dearborn, MI 48126
Mailing address
19470 Goldwin St
Southfield, MI 48075-7222
Phone (330) 592-1719
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | lrudolph536871@direct.hfhs.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 11, 2025 through Feb 11, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Multicare Health System | Past | Accepting new patients |
Interoperability endpoints
- lmartin@direct.dmc.org
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616544000000",
"number": "1922427160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19470 GOLDWIN ST",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480757222",
"telephone_number": "330-592-1719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5500 AUTO CLUB DR",
"city": "DEARBORN",
"state": "MI",
"postal_code": "48126",
"telephone_number": "313-425-4500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDOLPH",
"first_name": "LO'RELL",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-15",
"last_updated": "2021-03-24",
"certification_date": "2021-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "5101021994",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "lrudolph536871@direct.hfhs.org",
"affiliation": "N",
"address_1": "5500 Auto Club Dr",
"city": "Dearborn",
"state": "MI",
"country_code": "US",
"postal_code": "48126",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.