GLEN H RUDOLPH (M.D.) – Orthopaedic Surgery Physician, NPI 1124258223
Orthopaedic Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
819 ORTHOPEDIC SURGERY in MN
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Provider Addresses for GLEN H RUDOLPH (M.D.)
404, East 1st Street, Duluth, Saint Louis County, Minnesota, 55812, United States
DULUTH, MN 558052297
Phone: (218) 722-5513
Fax: (218) 722-6515
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 24 Open Payments records for all available years, with a total value of $1,031.
Total Amount is formed as General ($1,031) + Research ($0) + Ownership ($0) = $1,031.
Last reported payment date: 2024-12-10 • Largest payer in this snapshot: Stryker Corporation ($529).
Total Amount
$1,031
General + Research + Ownership
Payments
24
Total payment records
General Amount
$1,031
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Stryker Corporation | $529 |
| Foundation Medical, Llc | $324 |
| Arthrex, Inc. | $122 |
| Zimmer Biomet Holdings, Inc. | $57 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-02-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20121001000111 | I | Orthopedic Surgery | WI | TBD |
| I20190207000534 | I | Orthopedic Surgery | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 205 | 36 | $0 |
| 20610 | Aspiration and/or injection of fluid from large joint | 81 | 62 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 58 | 58 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 45 | 37 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 45 | 39 | $0 |
Insurance plans in this area (ZIP 55805)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| ORTHOPEDIC SURGERY | WI | 20610 | Aspiration and/or injection of large joint or joint capsule | 119 | 93 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| General Surgery | WI | |
| - | MN | |
| Family Practice, Emergency Medicine | MN | |
| - | MN | |
| Nurse Practitioner | MN | |
| - | AL | |
| P A T H O L O G Y | ND | |
| - | CA | |
| - | MN | |
| - | OK |
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