DR. KIM ANN RUTHERFORD M.D.
NPI 1013102649
Pediatrics - Pediatric Emergency Medicine in Mineola, NY
About Dr. Kim Ann Rutherford M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. KIM ANN RUTHERFORD M.D. (NPI 1013102649) is an individual pediatric emergency medicine provider in Mineola, New York, licensed in Pennsylvania (MD417166) and active in the NPI registry since September 2007. She is enrolled in Medicare PECOS and maintains a secondary practice location in Mesa.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Kim Ann Rutherford M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kim Rutherford reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Boynton Beach, FL 33426
- Reassigned Medicare billing, New York enrollment
- 7,712 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MINEOLA, NY 11501
MINEOLA, NY 11501
MINEOLA, NY 11501
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kim Rutherford's NPI number?
The NPI number for Kim Rutherford is 1013102649. It was assigned to this individual provider in the NPPES registry on September 6, 2007.
Where is Kim Rutherford located?
Kim Rutherford practices at 259 1st St, Mineola, NY 11501. The listed phone number is (717) 531-8955.
What is Kim Rutherford's specialty?
The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Emergency Medicine, with taxonomy code 2080P0204X.
Is Kim Rutherford enrolled in Medicare?
Yes. Kim Rutherford is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kim Rutherford's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kim Rutherford reassigns Medicare benefits to New York University (Boynton Beach, FL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kim Rutherford's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kim Rutherford was last updated on March 30, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Kim Ann Rutherford, M.D. · NPI 1013102649
Pediatric Emergency Medicine physician in Mineola, New York. Individual provider, active in the CMS NPPES registry since September 6, 2007.
## Identity
- **NPI:** 1013102649 (Entity type: Individual)
- **Enumerated:** September 6, 2007
- **Primary specialty:** Pediatrics - Pediatric Emergency Medicine · taxonomy 2080P0204X
- **State license:** MD417166 (Pennsylvania)
- **Sole proprietor:** No
## Practice location
- **Address:** 259 1ST ST, Mineola, NY 11501-3957
- **Phone:** (717) 531-8955
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** New York University (NPI 1285826438, Boynton Beach, FL), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 30, 2021
- **Other identifiers:** Medicaid 001868391 (PA); Other 169184 (PA)
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Source: [NPI Profile](https://npiprofile.com/npi/1013102649) · Data from the CMS NPPES public registry.