Ty Sanders Ruddell, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6023 Issued in AZ

Practice address

4864 E Baseline Rd
Suite #105
Mesa, AZ 85206-4629

Phone

(480) 558-1900

Fax

(480) 633-6086

NPI assigned

Dec 18, 2006

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 AZ

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Everest Medical Group Inc

  dba Everest Medical Group

  • General Practice Physician
  • Mesa, AZ
  • NPI 1184103350
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240790400000",
    "number": "1982767349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4864 E BASELINE RD",
            "address_2": "SUITE #105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064629",
            "telephone_number": "480-558-1900",
            "fax_number": "480-633-6086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4864 E BASELINE RD",
            "address_2": "SUITE #105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064629",
            "telephone_number": "480-558-1900",
            "fax_number": "480-633-6086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDELL",
        "first_name": "TY",
        "middle_name": "SANDERS",
        "name_prefix": "Mr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2009-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "6023",
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "AZ",
            "license": "3661",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Eugene Rubin, M.D.
• Ruc LLC
• Rucan Health Angels LLC (We Love Seniors)
• Kristy Rucker
• Ruddell Chiropractic Center Inc.
• Tom Richard Ruddy
• Lindsay M Ruder, PA-C
• Yasir Rudha, M.D.
• Melissa A Rudolph, PT, DPT
• Kathleen Ann Ruffin, RDH

• Chiropractor in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.