Active NPI
Rudolph Rousseau
- Psychologist
- Saint Paul, MN
National Provider Identifier
1811062029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1420
- Practice address
- 560 Concordia Ave
Ste 1100
Saint Paul, MN 55103-2443 - Phone
- (651) 325-2766
- NPI assigned
- Nov 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1420 | MN | Primary |
Addresses
Primary practice location
560 Concordia Ave
Ste 1100
Saint Paul, MN 55103-2443
Mailing address
5933 29TH PL N
Crystal, MN 55422-2559
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 113090 | Other | MN | UCAREBHP |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1420 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1811062029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5933 29TH PL N",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554222559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "560 CONCORDIA AVE",
"address_2": "STE 1100",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551032443",
"telephone_number": "651-325-2766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUSSEAU",
"first_name": "RUDOLPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-22",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "1420",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCAREBHP",
"identifier": "113090",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.