NPIMap

Individual provider Active NPI

H. Ruffin Walden III, PT

  • Orthopedic Physical Therapist
  • Springfield, IL
National Provider Identifier
1972703809
Registry record updated Dec 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
070-001474 Issued in IL
Practice address
1301 S Koke Mill Rd
Springfield, IL 62711-9252
Phone
(217) 547-9100
Fax
(217) 547-9247
NPI assigned
Jul 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 070-001474 IL Primary

Addresses

Primary practice location

1301 S Koke Mill Rd
Springfield, IL 62711-9252

Mailing address

PO Box 9469
Springfield, IL 62791-9469
Phone (217) 547-9100

Other identifiers 2

IdentifierTypeStateIssuer
P00769841OtherILRAILROAD MEDICARE
916500OtherILMEDICARE ID #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-001474ILMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Lincolnland Physical Therapy Past Accepting new patients
Orthopaedic Center of Il Past Accepting new patients
Advanced Healthcare Services, LLC PastSince Dec 4, 2019 Accepting new patients
Orthopaedic Center of Illinois Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262131200000",
    "number": "1972703809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9469",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627919469",
            "telephone_number": "217-547-9100",
            "fax_number": "217-547-9247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 S KOKE MILL RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119252",
            "telephone_number": "217-547-9100",
            "fax_number": "217-547-9247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDEN",
        "first_name": "H.",
        "middle_name": "RUFFIN",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-19",
        "last_updated": "2009-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IL",
            "license": "070-001474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00769841",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID #",
            "identifier": "916500",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2009; 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.