Individual provider Active NPI

Adam Jeffrey Rupp, DO

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Sartell, MN
National Provider Identifier
1053940056
Registry record updated Sep 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
79270 Issued in MN
Practice address
804 23Rd St S
Sartell, MN 56377-4705
Phone
(320) 230-7788
NPI assigned
Apr 2, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 9410217 KS
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 79270 MN Primary
Internal Medicine Physician 207R00000X 9410217 KS
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

804 23Rd St S
Sartell, MN 56377-4705

Mailing address

804 23Rd St S
Sartell, MN 56377-4705
Phone (320) 230-7788

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20251117000358 MN Practitioner - Physical Medicine and Rehabilitation 2264856210 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Center for Pain Management, P.a.Group PAC ID 8820008832, 15 clinicians

Practice addresses (Care Compare)

519 22ND Ave E
Alexandria, MN 56308-4652
Phone (320) 219-7611

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9410217KSMDInternal Medicine Physician
79270MNMDPain Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Pain Management, P.a. CurrentSince Aug 4, 2025 Accepting new patients

Locations

519 22nd Ave E
Alexandria, MN 56308
Phone (320) 219-7611

15620 Edgewood Dr
Ste 200
Brainerd, MN 56401
Phone (218) 270-3111

804 23rd St S
Sartell, MN 56377
Phone (320) 230-7788

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756857600000",
    "number": "1053940056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 23RD ST S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563774705",
            "telephone_number": "320-230-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 23RD ST S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563774705",
            "telephone_number": "320-230-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUPP",
        "first_name": "ADAM",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-02",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "KS",
            "license": "9410217",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MN",
            "license": "79270",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "9410217",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

Verify at the official NPI Registry.