OLAF JONATHAN RUSTAD MD NPI 1174586440

NPI Information

  • NPI: 1174586440
  • Provider Name: OLAF JONATHAN RUSTAD, MD
  • Classification: Dermatology - 207N00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4480 CENTERVILLE ROAD
    WHITE BEAR LAKE, MN
    ZIP 55127
  • Phone: (651) 484-2724

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NPI Details

Olaf Jonathan Rustad, MD is a dermatology in White Bear Lake, MN with 36 years of experience. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. Olaf Jonathan Rustad, MD NPI is 1174586440. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4480 CENTERVILLE ROAD
WHITE BEAR LAKE, MN
ZIP 55127-674
Phone: (651) 484-2724
Fax: (651) 484-2723

The NPI 1174586440 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Destruction of precancer skin growth, 2-14 growths (HCPCS:17003)
  • Established patient office or other outpatient visit, 30-39 minutes (HCPCS:99214)
  • Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)
  • Destruction of precancer skin growth, 1 growth (HCPCS:17000)
  • Destruction of skin growth, 1-14 growths (HCPCS:17110)
  • Obtaining data needed to develop the optimal radiation treatment, 1 treatment area (HCPCS:77280)
  • Superficial and/or low voltage radiation treatment delivery (HCPCS:77401)
  • Ultrasonic guidance for placement of radiation therapy fields (HCPCS:G6001)
  • Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks (HCPCS:17311)
  • Established patient office or other outpatient visit, 10-19 minutes (HCPCS:99212)
  • Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks (HCPCS:17312)
  • Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less (HCPCS:11310)
  • New patient office or other outpatient visit, 30-44 minutes (HCPCS:99203)
  • Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg) (HCPCS:J7308)
  • Application of light with debridement to destroy precancer skin growth (HCPCS:96574)
  • New patient office or other outpatient visit, 45-59 minutes (HCPCS:99204)
  • Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm (HCPCS:11311)
  • Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm (HCPCS:13132)
  • Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)
  • Shaving of skin growth of body, arms, or legs, 0.5 cm or less (HCPCS:11300)
  • Complicated repair of wound of scalp, arms, or legs, 2.6-7.5 cm (HCPCS:13121)
  • Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm (HCPCS:11301)
  • Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm (HCPCS:11302)
  • Complicated repair of wound of trunk, 2.6-7.5 cm (HCPCS:13101)
  • Continuing radiation therapy consultation per week (HCPCS:77336)
  • New patient office or other outpatient visit, 15-29 minutes (HCPCS:99202)
  • Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm (HCPCS:17282)
  • Biopsy of related skin growth, first growth (HCPCS:11102)
  • Destruction of precancer skin growth, 15 or more growths (HCPCS:17004)
  • Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm (HCPCS:11306)
  • Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm (HCPCS:11312)
  • Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm (HCPCS:11602)
  • Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm (HCPCS:17262)
  • Melanoma (skin cancer) excision (HCPCS:NAN03)

The enumeration date for this NPI number is 4/8/2006 and was last updated on 9/29/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207N00000XDermatology1938363MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1D98155MEDICARE UPINMINNESOTA
2070000195MEDICARE PIN
3070003227OTHERRR MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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