Jill Harriet Rusterholz, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

25083 Issued in MN

Practice address

6565 France Ave S
Suite 200
Edina, MN 55435-2137

Phone

(952) 806-0011

Fax

(952) 806-9741

NPI assigned

Jun 9, 2005

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457308800000",
    "number": "1154325942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6565 FRANCE AVE S",
            "address_2": "SUITE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352137",
            "telephone_number": "952-806-0011",
            "fax_number": "952-806-9741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6565 FRANCE AVE S",
            "address_2": "SUITE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352137",
            "telephone_number": "952-806-0011",
            "fax_number": "952-806-9741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTERHOLZ",
        "first_name": "JILL",
        "middle_name": "HARRIET",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2016-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "25083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "605307600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Edina, MN
• Providers in Edina, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.