David G Rustad, MD

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

30222 Issued in MN

Practice address

7710 Computer Ave
#110
Edina, MN 55435-5417

Phone

(952) 835-9442

Fax

(952) 835-9443

NPI assigned

Mar 31, 2006

Sex

Male

Sole proprietor

No

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

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Surgical Associates LTD

  • Pediatric Surgery Physician
  • Minneapolis, MN
  • NPI 1093778292
  Medicare reassignment NPD
• NPI 1598824880

  • NPI 1598824880
  NPD (past)

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344384000000",
    "number": "1013978568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE",
            "address_2": "#550",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044289",
            "telephone_number": "612-813-8000",
            "fax_number": "612-813-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7710 COMPUTER AVE",
            "address_2": "#110",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355417",
            "telephone_number": "952-835-9442",
            "fax_number": "952-835-9443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTAD",
        "first_name": "DAVID",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2012-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "MN",
            "license": "30222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "837782100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanne Kaye Runkel, PA C
• Stephanie Dawn Runyan, DO
• Russell N. Frys Jr,, DDS PA
• Laura Christine Russell, RD, CDE
• Margaret Patricia Russell, BS
• Jill Harriet Rusterholz, M.D.
• Lisa Marie Rutford, MA, LPCC
• RX Angels LLC
• Barb Ryan, L.M.T.
• Glen Ryan, MD

• Pediatric Surgery Physician in Edina, MN
• Providers in Edina, MN by specialty
• Pediatric Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2012; 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.