Provider Demographics
NPI:1023070711
Name:RITTELMEYER, JAMES THOMAS (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:RITTELMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N 18TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5712
Mailing Address - Country:US
Mailing Address - Phone:318-361-9900
Mailing Address - Fax:318-361-0428
Practice Address - Street 1:1100 N 18TH ST STE 100
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5712
Practice Address - Country:US
Practice Address - Phone:318-361-9900
Practice Address - Fax:318-361-0428
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043891207RC0000X, 207RI0011X
LAMD.208039207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000581564OtherWV BLUE SHIELD
WV0072165000Medicaid
9332051OtherWV MEDICARE B GROUP
000875693OtherWV BLUE SHIELD GROUP
VA006046401Medicaid
08248200000OtherQUAL CHOICE PROFESSIONAL
MD550941601OtherWV MEDICAID GRP IN WV
RI4100801OtherWV MEDICARE B
053726OtherANTHEM PROFESSIONAL
MD533451900Medicaid
MD550941600OtherMD MEDICAID GRP IN VA
WV9371521OtherMEDICARE B GROUP 2/1/07
C00085OtherVA MEDICARE B GROUP
00656346OtherRAILROAD MEDICARE
2119650OtherMAMSI PROFESSIONAL
WV3810003817OtherWV MEDICAID GRP
44157OtherSENTARA PROFESSIONAL
2119650OtherMAMSI PROFESSIONAL
B57456Medicare UPIN
MD533451900Medicaid
VA110002608Medicare PIN