Ruslan Rusanov, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D1268 Issued in SD

Practice address

350 Pine St
Rapid City, SD 57701-1669

Phone

(605) 721-8939

NPI assigned

Apr 7, 2020

Last updated

May 17, 2021By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Community Health Center of the Black Hills Inc

  dba Complete Health

  • Federally Qualified Health Center (FQHC)
  • Rapid City, SD
  • NPI 1669508677
  NPD (past)
• Community Health Center of the Black Hills, Inc

  • General Practice Physician
  • Rapid City, SD
  • NPI 1518219633
  NPD (past)

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1255960613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 PINE ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577011669",
            "telephone_number": "605-721-8939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 PINE ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577011669",
            "telephone_number": "605-721-8939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Van Buren St",
            "address_purpose": "LOCATION",
            "city": "Rapid City",
            "state": "SD",
            "postal_code": "577010969",
            "country_code": "US",
            "telephone_number": "605-721-8939",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1730 W 3rd St Fl Sreet1",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112231544",
            "country_code": "US",
            "telephone_number": "347-497-9207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSANOV",
        "first_name": "RUSLAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-07",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SD",
            "license": "D1268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122300000X",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Lee Rude, PT
• Jim Ruhe
• Rita Rumbaugh, RN
• Carol Ann Runcik, L.M.T
• Derric Oliver Running Horse, ACT
• Linda Rush, MS, LPC, CCDCIII
• Tristen Rush, PT
• Rushmore Ambulatory Surgery Center (Black Hills Pediatric Dentistry Surgery Center)
• Rushmore Clinic, P.C.
• Rushmore Crossing Vision Center, LLC

• Dentist in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Dentist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; 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.