Kendra M Ruckman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9106918 Issued in FL

Practice address

205 E Nasa Blvd
Melbourne, FL 32901-1950

Phone

(321) 361-5620

Fax

(321) 434-3511

NPI assigned

Mar 10, 2010

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 5

Other names 1

• Kendra M Dewey Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Health First Privia Medical GroupGroup PAC ID 3173965993, 247 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Palm Bay Hospital Hospital, Palm Bay, FL, CCN 100316
• Holmes Regional Medical Center Hospital, Melbourne, FL, CCN 100019
• Viera Hospital Hospital, Melbourne, FL, CCN 100315
• Cape Canaveral Hospital Hospital, Cocoa Beach, FL, CCN 100177

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

Interoperability endpoints

• Direct secure messaging: kendra.ruckman.1@8042.direct.athenahealth.com

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.

• Privia Medical Group Florida, LLC

  • General Practice Physician
  • Indialantic, FL
  • NPI 1700649043
  Medicare reassignment Care Compare group

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

• Cape Canaveral Hospital, Inc.

  • General Acute Care Hospital
  • Cocoa Beach, FL
  • NPI 1184691610
  Care Compare affiliation
• Holmes Regional Medical Center, Inc

  • General Acute Care Hospital
  • Palm Bay, FL
  • NPI 1386940823
  Care Compare affiliation
• Holmes Regional Medical Center, Inc.

  • Air Ambulance
  • Melbourne, FL
  • NPI 1235312281

  Hospital

  Care Compare affiliation
• Holmes Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Melbourne, FL
  • NPI 1295702728
  Care Compare affiliation
• Viera Hospital Inc

  • General Acute Care Hospital
  • Melbourne, FL
  • NPI 1730494816
  Care Compare affiliation

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

{
    "created_epoch": "1268179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1942523600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E NASA BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011950",
            "telephone_number": "321-361-5620",
            "fax_number": "321-434-3511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCKMAN",
        "first_name": "KENDRA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-10",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005799",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013210300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE (BCBS)",
            "identifier": "Y0E5E",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL MEDICARE",
            "identifier": "GO616Y",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL RR MEDICARE",
            "identifier": "P01165565",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9284904",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENDRA",
            "last_name": "DEWEY",
            "middle_name": "M",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mario E Ruberte, MD
• Laura Isabel Rubio Rodriguez, BS, DC
• Neli Rubio, APRN
• Aaron W Ruble
• Deborah A Ruby, SLP
• Patricia Rufo, RRT
• Alyssa M Ruiz-Ginory
• Francisco Roberto Ruiz, MD
• Katherine Ruiz
• Ruddy E Ruiz, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; 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.