Jennifer Elaine Rousseau, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

54757 Issued in MN

Practice address

11107 Ulysses St NE Ste 100
Blaine, MN 55434-4264

Phone

(763) 333-7733

Fax

(763) 333-7711

NPI assigned

Oct 29, 2008

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Child and Teen Medical Center

  • Pediatrics Physician
  • Blaine, MN
  • NPI 1225158520
  NPD

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

{
    "created_epoch": "1225238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1285887653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11107 ULYSSES ST NE STE 100",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344264",
            "telephone_number": "763-333-7733",
            "fax_number": "763-333-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11107 ULYSSES ST NE STE 100",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344264",
            "telephone_number": "763-333-7733",
            "fax_number": "763-333-7711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Osborne Rd NE Ste 215",
            "address_purpose": "LOCATION",
            "city": "Fridley",
            "state": "MN",
            "postal_code": "554322780",
            "country_code": "US",
            "telephone_number": "763-333-7733",
            "fax_number": "763-333-7711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROUSSEAU",
        "first_name": "JENNIFER",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-29",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "54757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Blaine, MN
• Providers in Blaine, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.