DR. KIM ANN RUTHERFORD M.D.
NPI 1013102649
Pediatrics - Pediatric Emergency Medicine in Mineola, NY

Q: 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.

Q: What is Kim Rutherford's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Emergency Medicine, with taxonomy code 2080P0204X.

Q: When was this NPI record last updated?

The NPPES record for Kim Rutherford was last updated on March 30, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since September 06, 2007PECOS Enrolled

259 1ST ST, MINEOLA, NY 11501(717) 531-8955 Get Directions Write a Review

NPPES record last updated: March 30, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Mar 30, 2021, Mar 17, 2018, Jan 10, 2018 (3 updates tracked since 2018).

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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

NPI1013102649

Entity TypeIndividualFemale

Primary Taxonomy2080P0204X

Provider Legal NameDR. KIM ANN RUTHERFORDCredential: M.D.

Location Address259 1ST STMineola, NY 11501-3957

Mailing Address259 1st StMineola, NY 11501-3957

Phone(717) 531-8955

Sole ProprietorNo

Enumeration DateSeptember 6, 2007

Last NPPES UpdateMarch 30, 20213 updates tracked since enumeration

NPPES CertifiedMarch 30, 2021

✔ NPI 1013102649 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Pediatric Emergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080P0204X

Licenses✔ Licensed in PA · MD417166✔ Licensed in AZ · 37476

Definition

A pediatrician who has special qualifications to manage emergencies in infants and children.

Also ListedPediatricsTaxonomy 208000000X · License 37476 (AZ)

259 1ST ST, Mineola, NY 11501

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Secondary Practice Location 1

Location 11400 S Dobson RdMesa, AZ 85202-4707 · Phone (480) 456-9500 · Fax (480) 820-7623

Other Identifiers 2

Medicaid001868391PA

Other169184PA · Medicare

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.