NPIMap

Individual provider Active NPI

Deborah Hudleston, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Minneapolis, MN
National Provider Identifier
1578959607
Registry record updated Oct 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
67638 Issued in MN
Practice address
420 Delaware St SE
Graduate Medical Education - University of Minnesota
Minneapolis, MN 55455-0341
Phone
(612) 626-4913
NPI assigned
Apr 15, 2015
Last updated
Oct 7, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physical Medicine & Rehabilitation Physician 208100000X 67638 MN Primary

Addresses

Primary practice location

420 Delaware St SE
Graduate Medical Education - University of Minnesota
Minneapolis, MN 55455-0341

Mailing address

420 Delaware St SE
Graduate Medical Education - University of Minnesota
Minneapolis, MN 55455-0341
Phone (612) 626-4913

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200721000780 MN Practitioner - Physical Medicine and Rehabilitation 8224333059 Reassigns benefits to 4 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics CurrentSince Jul 1, 2020 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Jul 1, 2020 Accepting new patients
Healtheast Medical Research Institute CurrentSince Oct 20, 2021 Accepting new patients
Fairview Express Care CurrentSince Jul 1, 2020 Accepting new patients
Healtheast Medical Research Insititue CurrentSince Oct 20, 2021 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Express Care CurrentSince Aug 17, 2020 Accepting new patients
Fairview Health Services CurrentSince Jul 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Aug 17, 2020 Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

420 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-6483

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1578959607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "GRADUATE MEDICAL EDUCATION - UNIVERSITY OF MINNESOTA",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-626-4913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "GRADUATE MEDICAL EDUCATION - UNIVERSITY OF MINNESOTA",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-626-4913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDLESTON",
        "first_name": "DEBORAH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-15",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "67638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.