Carlyn Dekoning Rudberg, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10371 Issued in MN

Practice address

4100 Hamline Ave N
Saint Paul, MN 55112-5700

Phone

(866) 389-2727

NPI assigned

Oct 31, 2007

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

Other identifiers 1

Other names 1

• Carlyn Joy Dekoning Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

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.

• Surgical Consultants, P.a.

  • Surgery Physician
  • Edina, MN
  • NPI 1366479651
  NPD (past)

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584144000000",
    "number": "1689853145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8251 COLUMBINE RD",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447610",
            "telephone_number": "866-389-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 HAMLINE AVE N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551125700",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDBERG",
        "first_name": "CARLYN",
        "middle_name": "DEKONING",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-31",
        "last_updated": "2020-03-14",
        "certification_date": "2020-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER'S LICENSE",
            "identifier": "T760272391313",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLYN",
            "last_name": "DEKONING",
            "middle_name": "JOY",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey J Rozinka, DDS
• RPH on the Go
• Rrecovery Services
• Diane Marie Rubright, PSYD, LP
• Ruby Mental Health PLLC
• Gail M Rudberg, NP
• Kathryn Alexis Rudd, AU.D.
• Katrina Rude, MA, LPCC
• Tricia Rude, CRNA MS
• Crystal Rudell, DNP

• Physician Assistant in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2020; 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.