Carla Rudolph, DO is a medicare enrolled "General Practice" physician in Edgewood, New Mexico. Her current practice location is
1851 Old Us 66, Edgewood, New Mexico. You can reach out to her office (for appointments etc.) via phone at
(505) 286-2396.
Carla Rudolph is licensed to practice in New Mexico (license number A-1770-13) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1104182328.
Physician's Profile
| Full Name | Carla Rudolph |
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| Gender | Female |
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| Speciality | General Practice |
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| Location | 1851 Old Us 66, Edgewood, New Mexico |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1104182328
- Provider Enumeration Date: 04/02/2012
- Last Update Date: 05/04/2020
Medicare PECOS Information:
- PECOS PAC ID: 1052568201
- Enrollment ID: I20180725002373
Medical Identifiers
Medical identifiers for Carla Rudolph such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1104182328 | NPI | - | NPPES |
| 1104182328 | Medicaid | NC | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 208D00000X | General Practice | A-1770-13 (New Mexico) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Carla Rudolph allows following entities to bill medicare on her behalf.
| Entity Name | Dlp Person Urgent Care Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1275043481 PECOS PAC ID: 9032478698 Enrollment ID: O20180108000023 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Carla Rudolph is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Carla Rudolph, DO 1851 Old Us 66, Edgewood, NM 87015-7200 Ph: (505) 286-2396 | Carla Rudolph, DO 1851 Old Us 66, Edgewood, NM 87015-7200 Ph: (505) 286-2396 |
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