Matthew John Rudberg, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10531 Issued in MN

Practice address

8225 Flying Cloud Dr
Eden Prairie, MN 55344-5315

Phone

(612) 518-7562

NPI assigned

Apr 1, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Minnesota Oncology Hematology, PA

  • Hematology & Oncology Physician
  • Saint Paul, MN
  • NPI 1528035995
  NPD (past)
• Minnesota Oncology Hematology, PA

  • Radiation Oncology Physician
  • Saint Paul, MN
  • NPI 1598305427
  NPD (past)
• Minnesota Oncology Hematology, PA

  • Hematology & Oncology Physician
  • Saint Paul, MN
  • NPI 1609911205
  NPD (past)

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494201600000",
    "number": "1962674705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8149 PENNSYLVANIA CIR",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554381131",
            "telephone_number": "612-598-4569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8225 FLYING CLOUD DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445315",
            "telephone_number": "612-518-7562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDBERG",
        "first_name": "MATTHEW",
        "middle_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-01",
        "last_updated": "2017-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10531",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2014-0066",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claire Rosen, MA, LPCC, LADC
• Peyton Matthew Roteff, MD
• Eira Roth, M.D.
• Stephen Edward Roudabush, RPH
• Royal Care Chiropractic PLLC
• Margaret A Rudolph, APN
• Tamara Mae Ruedebusch, OTR/L
• Josie Christine Runyan, DC
• Martin Joseph Ruocco, M.D.
• Peter L. Russell, MD

• Physician Assistant in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2017; 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.