Individual provider Active NPI

Coty Ruffalo

  • Community Health Worker
  • Lake Geneva, WI
National Provider Identifier
1982496691
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Practice address
1885 Dodge St
Lake Geneva, WI 53147-1319
Phone
(916) 500-3649
NPI assigned
May 19, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Community Health Worker 172V00000X Primary

Addresses

Primary practice location

1885 Dodge St
Lake Geneva, WI 53147-1319

Mailing address

1885 Dodge St
Lake Geneva, WI 53147-1319
Phone (916) 500-3649

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)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1747612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1982496691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1885 DODGE ST",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531471319",
            "telephone_number": "916-500-3649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1885 DODGE ST",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531471319",
            "telephone_number": "916-500-3649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUFFALO",
        "first_name": "COTY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-19",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Geneva, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; 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.