DIANNE M RUDOLPH (NP) – Gerontology Nurse Practitioner, NPI 1427095777
Gerontology Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
22,204 NURSE PRACTITIONER in TX
Provider Addresses for DIANNE M RUDOLPH (NP)
12501 JUDSON RD STE 102
LIVE OAK, TX 782334117
Phone: (210) 729-2180
Type: Location
124 E BANDERA RD # 102
BOERNE, TX 780062849
Phone: (830) 816-2312
Fax: (830) 816-2349
Type: Mailing
4330, Medical Drive, South Texas Medical Center, San Antonio, Bexar County, Texas, 78229, United States
STE 500
SAN ANTONIO, TX 782293318
Phone: (210) 426-6230
Fax: (210) 599-2104
Type: Mailing
Passport Health San Antonio Travel Clinic, 5282, Medical Drive, South Texas Medical Center, San Antonio, Bexar County, Texas, 78229, United States
SUITE 312
SAN ANTONIO, TX 782294849
Phone: (210) 699-3815
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $30.
Total Amount is formed as General ($30) + Research ($0) + Ownership ($0) = $30.
Last reported payment date: 2024-01-22 • Largest payer in this snapshot: Organogenesis Inc. ($22).
Total Amount
$30
General + Research + Ownership
Payments
2
Total payment records
General Amount
$30
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-01-22
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Organogenesis Inc. | $22 |
| CashFlow Solutions, LLC | $8 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-01-31
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050131000379 | I | Nurse Practitioner | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 11042 | Removal of skin and tissue, 20.0 sq cm or less | 226 | 59 | $0 |
| 11045 | Removal of skin and tissue, each additional 20.0 sq cm or less | 179 | 17 | $0 |
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes | 147 | 46 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 139 | 52 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 95 | 46 | $0 |
Insurance plans in this area (ZIP 78233)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | ND | |
| Nurse Practitioner | TX | |
| - | TX | |
| - | TX | |
| Physician Assistant | TX | |
| Nurse Practitioner | TX | |
| Family Practice | TX | |
| Physician Assistant | TX | |
| - | TX | |
| - | TX |
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