Individual provider Active NPI

Ruth A Rustad, MD

  • Dermatology Physician
  • White Bear Lake, MN
National Provider Identifier
1689631038
Registry record updated Aug 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
38316 Issued in MN
Practice address
4480 Centerville Rd
White Bear Lake, MN 55127-3674
Phone
(651) 484-2724
Fax
(651) 484-2723
NPI assigned
Apr 28, 2006
Last updated
Aug 1, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 38316 MN
Dermatology Physician 207N00000X 38316 MN Primary

Addresses

Primary practice location

4480 Centerville Rd
White Bear Lake, MN 55127-3674

Mailing address

4480 Centerville Rd
White Bear Lake, MN 55127-3674
Phone (651) 484-2724

Other identifiers 1

IdentifierTypeStateIssuer
110202652OtherMNRR MEDICARE

Other names 1

  • Ruth A Anderson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040520000119 MN Practitioner - Internal Medicine 0042201964 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Minnesota Medical School, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

14130 60TH St N
Stillwater, MN 55082-6354
Phone (651) 484-2724

25 Lake St N
Suite 200
Forest Lake, MN 55025-2537
Phone (651) 430-2724

4480 Centerville Rd
White Bear Lake, MN 55127-3674
Phone (651) 484-2724

Merit-based Incentive Payment System (MIPS)

Final score
74.85 of 100Reported as group
Quality
70.56
Promoting interoperability
81
Improvement activities
40
Cost
61.43

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions338
Removal or shaving of skin growth39
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38316MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Dermatology Care Medical Cosmetic and Surgery PA Dermatology Current Accepting new patients
Advanced Dermatology Care Medical Cosmetic and Surgery PA Dermatology CurrentSince Feb 1, 2004 Accepting new patients
Advanced Dermatology Care Medical Cosmetic and Surgery PA Dermatology PastSince Mar 17, 2024 Accepting new patients

Locations

25 Lake St N
Ste 200
Forest Lake, MN 55025
Phone (651) 430-2724

14130 60th St N
Stillwater, MN 55082
Phone (651) 484-2724

4480 Centerville Rd
White Bear Lk, MN 55127
Phone (612) 550-1152

Interoperability endpoints

  • Direct secure messaging: rrustad@adc.emadirect.md

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343779200000",
    "number": "1689631038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4480 CENTERVILLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551273674",
            "telephone_number": "651-484-2724",
            "fax_number": "651-484-2723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4480 CENTERVILLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551273674",
            "telephone_number": "651-484-2724",
            "fax_number": "651-484-2723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTAD",
        "first_name": "RUTH",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-28",
        "last_updated": "2012-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "38316",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "38316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110202652",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RUTH",
            "last_name": "ANDERSON",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in White Bear Lake, MN

Sources for this page

Verify at the official NPI Registry.