NPIMap

Individual provider Active NPI

Glen H Rudolph, M.D.

  • Orthopaedic Surgery Physician
  • Duluth, MN
National Provider Identifier
1124258223
Registry record updated Mar 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
50713 Issued in MN
Practice address
1000 E 1St St Ste 404
Duluth, MN 55805-2297
Phone
(218) 722-5513
Fax
(218) 722-6515
NPI assigned
Jul 23, 2009
Last updated
Mar 12, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 50713 MN Primary
Orthopaedic Surgery Physician 207X00000X 55776 WI

Addresses

Primary practice location

1000 E 1St St Ste 404
Duluth, MN 55805-2297

Mailing address

1000 E 1St St Ste 404
Duluth, MN 55805-2297
Phone (218) 722-5513

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121001000111 WI Practitioner - Orthopedic Surgery 5092964445 Reassigns benefits to 1 organization
I20190207000534 MN Practitioner - Orthopedic Surgery 5092964445 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Minnesota Medical School, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Associates of Duluth PAGroup PAC ID 1951294065, 37 clinicians
Grand Itasca Clinic and HospitalGroup PAC ID 8123939550, 328 clinicians
Range Regional Health ServicesGroup PAC ID 8022920024, 349 clinicians

Practice addresses (Care Compare)

1000 E 1St St
Duluth, MN 55805-2297
Phone (218) 722-5513

1400 Hwy 71
International Falls, MN 56649-2154
Phone (218) 283-4481

1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 326-3401

3605 Mayfair Ave
Hibbing, MN 55746-2935
Phone (218) 262-3441

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement12
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)33

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50713MNMDOrthopaedic Surgery Physician
55776WIMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Associates of Duluth, P.a. Orthopaedic Surgery CurrentSince Jan 10, 2019 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Jan 1, 2020 Accepting new patients
International Falls Memorial Hospital Association CurrentSince Mar 15, 2019 Accepting new patients
Range Regional Health Services CurrentSince Apr 15, 2021 Accepting new patients
International Falls Memorial Hospital Association CurrentSince Mar 15, 2019 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Jan 1, 2020 Accepting new patients
Range Regional Health Services Current Accepting new patients
Range Regional Health Services CurrentSince Apr 15, 2021 Accepting new patients

Locations

1000 E 1st St
Duluth, MN 55805
Phone (218) 625-1884

1000 E 1st St
Ste 400
Duluth, MN 55805
Phone (218) 625-2728

1000 E 1st St
Ste 404
Duluth, MN 55805
Phone (218) 722-5513

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401

3429 E Beltline
Hibbing, MN 55746
Phone (218) 263-3880

3605 Mayfair Ave
Hibbing, MN 55746
Phone (218) 262-3441

750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441

1400 Highway 71
Intl Falls, MN 56649
Phone (218) 283-4481

402 E Platt Ave
Nashwauk, MN 55769
Phone (218) 885-2858

1700 W Stout St
Rice Lake, WI 54868
Phone (715) 236-6133

Organizations & group practices 8

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.

Hospital & facility affiliations 30

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552348800000",
    "number": "1124258223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E 1ST ST STE 404",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052297",
            "telephone_number": "218-722-5513",
            "fax_number": "218-722-6515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E 1ST ST STE 404",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052297",
            "telephone_number": "218-722-5513",
            "fax_number": "218-722-6515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "GLEN",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-23",
        "last_updated": "2019-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "50713",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "55776",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.