Individual provider Active NPI

Ehren Rudolph, M.D., PH.D

  • Surgery Physician
  • Saint Paul, MN
National Provider Identifier
1952628604
Registry record updated Sep 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
56702 Issued in MN
Practice address
640 Jackson St
Saint Paul, MN 55101-2502
Phone
(651) 254-5151
Fax
(651) 254-4123
NPI assigned
Apr 20, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X 56702 MN
Surgery Physician 208600000X 56702 MN Primary

Addresses

Primary practice location

640 Jackson St
Saint Paul, MN 55101-2502

Mailing address

420 Delaware St SE
Minneapolis, MN 55455-0341
Phone (612) 625-3926

Other practice location 1

420 Delaware St SE
Minneapolis, MN 55455-0341
Phone (612) 625-3926

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130627000610 MN Practitioner - Neurosurgery 7618117417 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of Wisconsin School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians

Practice addresses (Care Compare)

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 581-5400

3366 Oakdale Ave N
Suite 200
Robbinsdale, MN 55422-2962
Phone (763) 520-5200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
56702MNMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care Surgery CurrentSince Apr 16, 2019 Accepting new patients
Fairview Health Services Current Accepting new patients
North Memorial Health Care CurrentSince Aug 1, 2019 Accepting new patients
Group Health, Inc. Current Accepting new patients
North Memorial Health Care CurrentSince Aug 1, 2019 Accepting new patients
Fairview Health Services CurrentSince Apr 16, 2019 Accepting new patients
Group Health, Inc. CurrentSince Jul 1, 2013 Accepting new patients

Locations

303 E Nicollet Blvd
Ste 300
Burnsville, MN 55337
Phone (952) 435-4140

6405 France Ave S
Ste 440
Edina, MN 55435
Phone (952) 927-7004

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

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

8170 33rd Ave S
Minneapolis, MN 55425
Phone (952) 883-5463

420 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-6483

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

3366 Oakdale Ave N
Ste 200
Robbinsdale, MN 55422
Phone (763) 287-5000

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

Organizations & group practices 8

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": "1271721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567468800000",
    "number": "1952628604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-625-3926",
            "fax_number": "612-625-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012502",
            "telephone_number": "651-254-5151",
            "fax_number": "651-254-4123"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 Delaware St SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554550341",
            "country_code": "US",
            "telephone_number": "612-625-3926",
            "fax_number": "612-625-1717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "EHREN",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-20",
        "last_updated": "2019-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MN",
            "license": "56702",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "56702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.