Walter Kenneth Rush IV, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

45379 Issued in MN

Practice address

275 4TH St E
Saint Paul, MN 55101-1696

Phone

(651) 389-4690

Fax

(651) 389-4691

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1003907155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 4TH ST E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551011696",
            "telephone_number": "651-389-4690",
            "fax_number": "651-389-4691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 4TH ST E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551011696",
            "telephone_number": "651-389-4690",
            "fax_number": "651-389-4691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSH",
        "first_name": "WALTER",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "45379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4400606",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seth Runkle, PHARM D.
• Henry J Rupp, MD
• William M Rupp, MD
• Robert D Rupprecht, DDS, MS
• Kellie Jean Rusch, APRN, CNP
• Christine Rushfeldt, LICSW, LADC
• Anne Russell
• Stacy Russell, LPCC
• Jeffrey Harold Russum, MD
• Peter Karl Rusterholz, M.D.

• Psychiatry Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Psychiatry Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.