Individual provider Active NPI

Michael Rudolph, MD

  • Internal Medicine Physician
  • Fridley, MN
National Provider Identifier
1619296563
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
57068 Issued in MN
Practice address
550 Osborne Rd NE
Fridley, MN 55432-2718
Phone
(763) 236-3518
Fax
(763) 236-3524
NPI assigned
May 18, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 57068 MN Primary

Addresses

Primary practice location

550 Osborne Rd NE
Fridley, MN 55432-2718

Mailing address

550 Osborne Rd NE
Fridley, MN 55432-2718
Phone (763) 236-3518

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mrudolph207473@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130815000726 MN Practitioner - Internal Medicine 0749422012 Reassigns benefits to 1 organization
I20190815000627 WI Practitioner - Internal Medicine 0749422012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

1629 E Division St
River Falls, WI 54022-1571
Phone (715) 307-6000

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 863-4000

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone (763) 236-6000

520 Osborne Rd NE
Fridley, MN 55432-2718

550 Osborne Rd NE
Fridley, MN 55432-2718
Phone (763) 427-9980

PO Box
Minneapolis, MN 55440-0043

Hospital & facility affiliations

  • Mercy Hospital Hospital, Coon Rapids, MN, CCN 240115

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Single Specialty Current Accepting new patients
Allina Health System Single Specialty CurrentSince Sep 1, 2013 Accepting new patients
Allina Health System CurrentSince Sep 1, 2013 Accepting new patients
Allina Health System CurrentSince Aug 1, 2019 Accepting new patients
Allina Health System Single Specialty Current Accepting new patients
Allina Health System Past Accepting new patients

Locations

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

550 Osborne Rd NE
Minneapolis, MN 55432
Phone (763) 236-3800

1629 E Division St
River Falls, WI 54022
Phone (715) 307-6000

Interoperability endpoints

  • Direct secure messaging: mrudolph207473@excellian.direct.allina.com

Organizations & group practices 6

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1274140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1619296563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 OSBORNE RD NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322718",
            "telephone_number": "763-236-3518",
            "fax_number": "763-236-3524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 OSBORNE RD NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322718",
            "telephone_number": "763-236-3518",
            "fax_number": "763-236-3524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-18",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "57068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mrudolph207473@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "550 OSBORNE RD NE",
            "city": "FRIDLEY",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554322718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.