NPIMap

Individual provider Active NPI

Bradley H Rutten, PAC

  • Physician Assistant
  • Sartell, MN
National Provider Identifier
1770559239
Registry record updated Dec 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9022 Issued in MN
Practice address
2251 Connecticut Ave S
Sartell, MN 56377-2486
Phone
(320) 253-5220
Fax
(320) 203-2113
NPI assigned
Feb 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9022 MN Primary

Addresses

Primary practice location

2251 Connecticut Ave S
Sartell, MN 56377-2486

Mailing address

2251 Connecticut Ave S
Sartell, MN 56377-2486
Phone (320) 253-5220

Other identifiers 1

IdentifierTypeStateIssuer
472752500MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071212000151 MN Practitioner - Physician Assistant 1355431578 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Simplicity Health PAGroup PAC ID 1557617354, 16 clinicians

Practice addresses (Care Compare)

3290 42ND Ave S
Saint Cloud, MN 56301-6251
Phone (320) 227-5000

Hospital & facility affiliations

  • Centracare Home Health Home health agency, Waite Park, MN, CCN 247117
  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Methodist Hospital CurrentSince Mar 28, 2020 Accepting new patients
Park Nicollet Clinic CurrentSince Mar 28, 2020 Accepting new patients
Group Health, Inc. CurrentSince Jan 1, 2012 Accepting new patients
Group Health, Inc. CurrentSince Jan 1, 2012 Accepting new patients

Locations

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

2251 Connecticut Ave S
Sartell, MN 56377
Phone (320) 253-5220

Interoperability endpoints

  • Direct secure messaging: brutten835@direct.centracare.com

Organizations & group practices 7

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 7

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": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448928000000",
    "number": "1770559239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2251 CONNECTICUT AVE S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772486",
            "telephone_number": "320-253-5220",
            "fax_number": "320-203-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2251 CONNECTICUT AVE S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772486",
            "telephone_number": "320-253-5220",
            "fax_number": "320-203-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTTEN",
        "first_name": "BRADLEY",
        "middle_name": "H",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2015-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "472752500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

Verify at the official NPI Registry.