NPIMap

Individual provider Active NPI

Paul David Hart Ruthenbeck, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Northfield, MN
National Provider Identifier
1720436231
Registry record updated May 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
303259 Issued in MN
Practice address
401 Division St S
Suite a
Northfield, MN 55057-2095
Phone
(507) 664-9407
Fax
(507) 664-3862
NPI assigned
May 25, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 303259 MN Primary

Addresses

Primary practice location

401 Division St S
Suite a
Northfield, MN 55057-2095

Mailing address

401 Division St S
Suite a
Northfield, MN 55057-2095
Phone (507) 664-9407

Other names 1

  • Paul David Ruthenbeck Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
303259MNMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Omada, Inc. Past Accepting new patients
Knox County General Health District Past Accepting new patients
Knox County General Health District Past Accepting new patients
Knox County General Health District Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1464134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464134400000",
    "number": "1720436231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 DIVISION ST S",
            "address_2": "SUITE A",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572095",
            "telephone_number": "507-664-9407",
            "fax_number": "507-664-3862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 DIVISION ST S",
            "address_2": "SUITE A",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572095",
            "telephone_number": "507-664-9407",
            "fax_number": "507-664-3862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HART RUTHENBECK",
        "first_name": "PAUL",
        "middle_name": "DAVID",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-25",
        "last_updated": "2016-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAUL",
            "last_name": "RUTHENBECK",
            "middle_name": "DAVID",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Northfield, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; 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.