Basic Information
| Provider Information | |||||||||
| NPI: | 1164427613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUPPEL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617011784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098295311 | ||||||||
| FaxNumber: | 3098278027 | ||||||||
| Practice Location | |||||||||
| Address1: | 834 N SEMINARY ST | ||||||||
| Address2: | STE 103 | ||||||||
| City: | GALESBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 614012852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098295311 | ||||||||
| FaxNumber: | 3098278027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 07/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 036064075 | IL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 180041717 | 01 | IL | RAILROAD MEDICARE | OTHER | 036064075 | 05 | IL | MEDICAID |