Active NPI
Susan Krista Rutten Wasson, M.D.
- Pediatrics Physician
- Osakis, MN
National Provider Identifier
1417920190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 42061
- Practice address
- 200 W. Nokomis St.
Osakis, MN 56360-8294 - Phone
- (320) 859-2366
- Fax
- (320) 859-5234
- NPI assigned
- Feb 10, 2006
- Last updated
- Mar 27, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | NU | ||
| Pediatrics Physician | 208000000X | 42061 | MN | Primary |
Addresses
Primary practice location
200 W. Nokomis St.
Osakis, MN 56360-8294
Mailing address
200 W. Nokomis St.
Osakis, MN 56360-8294
Phone (320) 859-2366
Other names 1
- Dr. Susan Krista Rutten
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 19, 2013 through Dec 19, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42061 | MN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679875200000",
"number": "1417920190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 W. NOKOMIS ST.",
"city": "OSAKIS",
"state": "MN",
"postal_code": "563608294",
"telephone_number": "320-859-2366",
"fax_number": "320-859-5234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W. NOKOMIS ST.",
"city": "OSAKIS",
"state": "MN",
"postal_code": "563608294",
"telephone_number": "320-859-2366",
"fax_number": "320-859-5234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUTTEN WASSON",
"first_name": "SUSAN",
"middle_name": "KRISTA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-10",
"last_updated": "2023-03-27",
"certification_date": "2023-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "42061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "RUTTEN",
"middle_name": "KRISTA",
"prefix": "DR.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Osakis, MN
- Jani Marie Helm
- Ind School Dist 213 Douglas & Todd Cos (Osakis School District 213)
- Eric Nefstead, PT, DPT, ATC
- Nurse Navigator Transportation LLC
- Lori Jean Rasmusen
- Bruce Michael Samson, MD
- Colleen Savageau
- Meghan Amanda Stadsklev, RN, CNP
- Terrace Heights Assisted Living Apartments (Galeon)
- Kellie Vannyhuis
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.