Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MR. SHANE MICHAEL RUDOLPH CRNP
NPI 1922696244
Nurse Practitioner in Philadelphia, PA

Q: What is Shane Rudolph's NPI number?

The NPI number for Shane Rudolph is 1922696244. It was assigned to this individual provider in the NPPES registry on January 3, 2021.

Q: What is Shane Rudolph's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Shane Rudolph was last updated on October 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 24 days 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 January 03, 2021PECOS Enrolled

3509 N BROAD ST, PHILADELPHIA, PA 19140(215) 707-8484(215) 707-5901 Get Directions Write a Review

NPPES record last updated: October 16, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Oct 16, 2026, Sep 22, 2026, Jan 3, 2021 (3 updates tracked since 2021).

On this page

About Mr. Shane Michael Rudolph Crnp NPPES

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

MR. SHANE MICHAEL RUDOLPH CRNP (NPI 1922696244) is an individual nurse practitioner in Philadelphia, Pennsylvania, licensed in Pennsylvania (SP023007) and active in the NPI registry since January 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1922696244

Entity TypeIndividualMale

Primary Taxonomy363L00000X

Provider Legal NameMR. SHANE MICHAEL RUDOLPHCredential: CRNP

Location Address3509 N BROAD STPhiladelphia, PA 19140-4105

Mailing Address3509 N Broad StPhiladelphia, PA 19140-4105 · (215) 707-3911

Phone(215) 707-8484

Fax(215) 707-5901

Sole ProprietorYes

Enumeration DateJanuary 3, 2021

Last NPPES UpdateOctober 16, 20263 updates tracked since enumeration

NPPES CertifiedOctober 16, 2026

✔ NPI 1922696244 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in PA · SP023007

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

3509 N BROAD ST, Philadelphia, PA 19140

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Shane Michael Rudolph Crnp 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19140 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$92.69 typical visit price

range $59.88 – $180.99

Typical copayment $23.17 (range $14.97 – $45.24)

Most-billed visit code 99203

Established Patient

$105.21 typical visit price

range $19.30 – $147.29

Typical copayment $26.30 (range $4.82 – $36.82)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

KEWAL KRISHAN MD

Thoracic Surgery (Cardiothoracic Vascular Surgery)

3509 N BROAD ST
PHILADELPHIA, PA 19140

Philadelphia County (215) 707-8484

KURT KUNZ M.D.

Internal Medicine

3509 N BROAD ST, SUITE 226
PHILADELPHIA, PA 19140

Philadelphia County (267) 512-4313

MEGHANA ASHOK PATIL

Internal Medicine (Cardiovascular Disease)

3509 N BROAD ST
PHILADELPHIA, PA 19140

Philadelphia County (215) 707-8484

TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Psychiatry & Neurology (Neurology)

3509 N BROAD ST, FL 6 EAST TUCMC
PHILADELPHIA, PA 19140

Philadelphia County (215) 707-6613

ROSHANI NARENDRAKUMAR PATEL PA-C

Physician Assistant

3509 N BROAD ST
PHILADELPHIA, PA 19140

Philadelphia County (215) 707-8484

DR. CHRISTOPHER WILLIAM AHMED MD

Ophthalmology

3509 N BROAD ST
PHILADELPHIA, PA 19140

Philadelphia County (800) 836-7536

RICHARD TIM LACHMAN MD

Psychiatry & Neurology (Neurology)

3509 N BROAD ST
PHILADELPHIA, PA 19140

Philadelphia County (215) 707-3040

TEMPLE FACULTY PRACTICE PLAN, INC

Otolaryngology

3509 N BROAD ST
PHILADELPHIA, PA 19140

Philadelphia County (215) 707-3663

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 Shane Rudolph's NPI number?

The NPI number for Shane Rudolph is 1922696244. It was assigned to this individual provider in the NPPES registry on January 3, 2021.

Where is Shane Rudolph located?

Shane Rudolph practices at 3509 N Broad St, Philadelphia, PA 19140. The listed phone number is (215) 707-8484.

What is Shane Rudolph's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Shane Rudolph enrolled in Medicare?

Yes. Shane Rudolph is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Shane Rudolph was last updated on October 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 24 days 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.