Physician Compare National (NPI:1962574806)

HEALTHCARE PROVIDER: GUSTAVE THEODORE RUCKERT M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1962574806
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6406023308
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120118000015
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RUCKERT
	Individual professional last name
Provider First Name	GUSTAVE
	Individual professional first name
Provider Middle Name	THEODORE
	Individual professional middle name
Provider Name Suffix Text	IV
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS
	Individual professional's medical school
Graduation Year	1971
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GENESEE VALLEY OBSTETRICS AND GYNECOLOGY PC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	1951326719
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	21 WILLOW POND WAY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	PENFIELD
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	145262687
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5856410399
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330125
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ROCHESTER GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y