Kyle Ellis Ruckman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

630 W Maple St
Farmington, NM 87401-6113

Phone

(505) 609-6349

Fax

(505) 609-2259

NPI assigned

Nov 5, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NM, CO2 enrollments

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 2

Specialty

Physician Assistant

Education

Boston University School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

San Juan Regional Medical Center, Inc.Group PAC ID 4587559505, 233 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• San Juan Regional Medical Center Inc Hospital, Farmington, NM, CCN 320005

Merit-based Incentive Payment System (MIPS)

Final score

90.97 of 100Reported as group

Quality

79.73

Promoting interoperability

100

Improvement activities

40

Cost

78.87

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• San Juan Regional Medical Center Inc

  • Gastroenterology Physician
  • Farmington, NM
  • NPI 1639662901
  Medicare reassignment Care Compare group NPD
• Digestive Health Associates Professional Corporation

  • Specialist
  • Durango, CO
  • NPI 1376522615
  Medicare reassignment
• San Juan Regional Medical Center Inc

  • Family Medicine Physician
  • Farmington, NM
  • NPI 1710589015
  NPD

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

• San Juan Regional Medical Center Inc

  • Rehabilitation Hospital Unit
  • Farmington, NM
  • NPI 1326663592
  Care Compare affiliation
• San Juan Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Farmington, NM
  • NPI 1427058510
  Care Compare affiliation

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

{
    "created_epoch": "1604534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1952902934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844088",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844088",
            "telephone_number": "505-609-2258",
            "fax_number": "505-609-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 W MAPLE ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016113",
            "telephone_number": "505-609-6349",
            "fax_number": "505-609-2259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCKMAN",
        "first_name": "KYLE",
        "middle_name": "ELLIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-05",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2020-0115",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Rottschafer
• Rebecca Rowe, DC
• Jeremy Sean Rowse, D.C.
• Ryan Taylor Rowse, DC
• Sarah Rubow, LCSW
• Jonathan B Rudolf, M.D.
• Roger G. Rung, P.T.
• Elysia Russell, LCSW
• Gordon D. Russell, O.D.
• Lacy Russell, WHNP-BC

• Physician Assistant in Farmington, NM
• Providers in Farmington, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.