TERESA L RUDOLPH (MD) – Family Medicine Physician, NPI 1104869379
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for TERESA L RUDOLPH (MD)
Mitchell F. Lundgaard Post Office, Sherman Place, Appleton, Outagamie County, Wisconsin, 54911, United States
APPLETON, WI 549128003
Phone: (920) 996-3200
Fax: (920) 738-5787
Type: Mailing
1504, South Commercial Street, Mahler Farm, Neenah, Winnebago County, Wisconsin, 54956, United States
NEENAH, WI 549564802
Phone: (920) 729-6088
Fax: (920) 729-6484
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2010-06-01
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 |
|---|---|---|---|---|
| I20100601000595 | I | Family Practice | WI | 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 |
|---|---|---|---|---|
| 36415 | Insertion of needle into vein for collection of blood sample | 52 | 47 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 37 | 36 | $0 |
| 80048 | Blood test, basic group of blood chemicals (calcium, total) | 26 | 25 | $0 |
| 83036 | Hemoglobin a1c level | 24 | 23 | $0 |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 20 | 20 | $0 |
Insurance plans in this area (ZIP 54912)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | WI | 83036 | Hemoglobin A1C level | 66 | 48 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | WI | |
| Family Practice | WI | |
| - | FL | |
| Hospitalist, Internal Medicine | MI | |
| P S Y C H I A T R Y | WI | |
| - | WI | |
| - | WA | |
| Physician Assistant | WI | |
| Family Practice | WI | |
| Nurse Practitioner | WI |
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