NPIMap

Individual provider Active NPI

Scott Rutchik, M.D.

  • Urology Physician
  • Mishawaka, IN
National Provider Identifier
1952356503
Registry record updated Sep 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
01057389 Issued in IN
Practice address
410 Park PL Ste B
Mishawaka, IN 46545-3557
Phone
(574) 855-5800
Fax
(574) 855-5805
NPI assigned
May 23, 2006
Last updated
Sep 4, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 01057389 IN Primary

Addresses

Primary practice location

410 Park PL Ste B
Mishawaka, IN 46545-3557

Mailing address

PO Box 2968
Elkhart, IN 46515-2968
Phone (574) 296-3200

Other identifiers 3

IdentifierTypeStateIssuer
200443540MedicaidIN
P00038154OtherINMEDICARE RAILROAD
021236800OtherINFEDERAL BLACK LUNG

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040708001006 IN Practitioner - Urology 7214928449 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Albert Einstein College of Medicine of Yeshiva University, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Privia Medical Group Indiana LLCGroup PAC ID 2365341674, 28 clinicians

Practice addresses (Care Compare)

303 N Nappanee St
Elkhart, IN 46514-2066
Phone 57429632003973

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01057389INMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group Indiana, LLC CurrentSince Jan 1, 2008 Accepting new patients
Privia Medical Group Indiana, LLC CurrentSince Jan 1, 2008 Accepting new patients
Privia Medical Group Indiana, LLC Current Accepting new patients
Saint Joseph Regional Medical Center, Inc. Past Accepting new patients
Greater Hartford Lithotripsy, LLC Urology Past Accepting new patients

Locations

303 S Nappanee St
Elkhart, IN 46514

230 E Day Rd
Ste 280
Mishawaka, IN 46545
Phone (574) 247-5646

410 Park Pl
#B
Mishawaka, IN 46545
Phone (574) 564-5863

1919 Lake Ave
Ste 102B
Plymouth, IN 46563
Phone (574) 335-6214

61 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 684-6777

Interoperability endpoints

  • Direct secure messaging: scott.rutchik.1@31626.direct.athenahealth.com
  • Direct secure messaging: scott.rutchik@elkhartc.eclinicaldirectplus.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220486400000",
    "number": "1952356503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2968",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465152968",
            "telephone_number": "574-296-3200",
            "fax_number": "574-296-3392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 PARK PL STE B",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453557",
            "telephone_number": "574-855-5800",
            "fax_number": "574-855-5805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTCHIK",
        "first_name": "SCOTT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IN",
            "license": "01057389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200443540",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00038154",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "021236800",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.