Roderick Duane Vansurksum, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D11417 Issued in MN

Practice address

11601 Minnetonka Mills Rd Ste F40
Minnetonka, MN 55305-5189

Phone

(952) 935-8420

Fax

(952) 935-0147

NPI assigned

Oct 18, 2007

Sex

Male

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

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2024 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: roderickvansurksum@sol.allscriptsdirect.net

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.

• Summit Orthopedics LTD

  • Clinic/Center
  • Woodbury, MN
  • NPI 1558870196
  NPD
• Centrasota Oral & Maxillofacial Surgeons, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Cloud, MN
  • NPI 1598710477
  NPD (past)
• Hennepin Faculty Associates

  • General Practice Physician
  • Minneapolis, MN
  • NPI 1063459485
  NPD (past)

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1699964320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11601 MINNETONKA MILLS RD STE F40",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055189",
            "telephone_number": "952-935-8420",
            "fax_number": "952-935-0147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11601 MINNETONKA MILLS RD STE F40",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055189",
            "telephone_number": "952-935-8420",
            "fax_number": "952-935-0147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANSURKSUM",
        "first_name": "RODERICK",
        "middle_name": "DUANE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-18",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D11417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "704432100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marta Hernandez Vallin, APRN
• Vanashree Ayurveda
• Megan Marie Vandeneng
• Kristin Marie Vanderiet, OTR
• Douglas Kent Vansteenwyk, DO
• Alissa Vasko
• Thomas D. Vasovski, FNP
• Iryna Vasyuta
• Marsden Claire Vaughan, M.ED., BCBA, LBA
• Christopher E. Vaughn, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; 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.

Verify at the official NPI Registry.