RANDAL RUDDERMAN MD
NPI 1639263676
Surgery - Plastic and Reconstructive Surgery in Alpharetta, GA

Q: What is Randal Rudderman's NPI number?

The NPI number for Randal Rudderman is 1639263676. It was assigned to this individual provider in the NPPES registry on October 3, 2006.

Q: What is Randal Rudderman's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Q: When was this NPI record last updated?

The NPPES record for Randal Rudderman was last updated on August 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.

Active since October 03, 2006PECOS Enrolled

3400-C OLD MILTON PKWY,, STE 450, ALPHARETTA, GA 30005(678) 566-7200(678) 566-7210 Get Directions Write a Review

NPPES record last updated: August 27, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Randal Rudderman Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RANDAL RUDDERMAN MD (NPI 1639263676) is an individual plastic and reconstructive surgery provider in Alpharetta, Georgia, licensed in Georgia (024863) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1639263676

Entity TypeIndividualMale

Primary Taxonomy2086S0122X

Provider Legal NameRANDAL RUDDERMANCredential: MD

Location Address3400-C OLD MILTON PKWY,, STE 450Alpharetta, GA 30005-3707

Mailing Address3400-c Old Milton Pkwy,, Ste 450Alpharetta, GA 30005-3707 · (678) 566-7200 · Fax (678) 566-7210

Phone(678) 566-7200

Fax(678) 566-7210

Sole ProprietorYes

Enumeration DateOctober 3, 2006

Last NPPES UpdateAugust 27, 2026

NPPES CertifiedAugust 27, 2026

✔ NPI 1639263676 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code2086S0122X

License✔ Licensed in GA · 024863

Definition

A surgeon who specializes in plastic and reconstructive surgery.

Also ListedSpecialistTaxonomy 174400000X · License 024863 (GA)

3400-C OLD MILTON PKWY,, Alpharetta, GA 30005

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Randal Rudderman Md 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.

Medicare Billing Reassignment

Medicare enrollment records show Randal Rudderman reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Northside Surgical Professional Services LLC

12 mi

Surgery

1000 JOHNSON FERRY RD NE
Atlanta, GA 30342

Reassigned Medicare billing, Georgia enrollment
487 clinicians in this Medicare group

NPI 1356630990 (855) 709-4535

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Randal Rudderman's NPI number?

The NPI number for Randal Rudderman is 1639263676. It was assigned to this individual provider in the NPPES registry on October 3, 2006.

Where is Randal Rudderman located?

Randal Rudderman practices at 3400-C Old Milton Pkwy, Ste 450, Alpharetta, GA 30005. The listed phone number is (678) 566-7200.

What is Randal Rudderman's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Is Randal Rudderman enrolled in Medicare?

Yes. Randal Rudderman is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Randal Rudderman's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Randal Rudderman reassigns Medicare benefits to Northside Surgical Professional Services LLC (Atlanta, GA). 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 Randal Rudderman'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 Randal Rudderman was last updated on August 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.