OLAF JONATHAN RUSTAD (MD) – Dermatology Physician, NPI 1174586440
Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
419 DERMATOLOGY in MN
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Provider Addresses for OLAF JONATHAN RUSTAD (MD)
4480, Centerville Road, White Bear Lake, Ramsey County, Minnesota, 55127, United States
WHITE BEAR LAKE, MN 551273674
Phone: (651) 484-2724
Fax: (651) 484-2723
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 38 Open Payments records for all available years, with a total value of $823.
Total Amount is formed as General ($823) + Research ($0) + Ownership ($0) = $823.
Last reported payment date: 2024-12-17 • Largest payer in this snapshot: REVANCE THERAPEUTICS, INC. ($281).
Total Amount
$823
General + Research + Ownership
Payments
38
Total payment records
General Amount
$823
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-17
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| REVANCE THERAPEUTICS, INC. | $281 |
| Regeneron Healthcare Solutions, Inc. | $85 |
| Organogenesis Inc. | $63 |
| GENZYME CORPORATION | $36 |
| UCB, Inc. | $33 |
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: 2005-08-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20050819000347 | I | Dermatology | 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 |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 510 | 95 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 337 | 225 | $0 |
| G6001 | Ultrasonic guidance for placement of radiation therapy fields | 322 | 29 | $0 |
| 77280 | Obtaining data needed to develop the optimal radiation treatment, 1 treatment area | 303 | 24 | $0 |
| 77401 | Superficial and/or low voltage radiation treatment delivery | 293 | 24 | $0 |
Insurance plans in this area (ZIP 55127)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DERMATOLOGY | MN | 13132 | Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet | 16 | 16 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MN | |
| Physician Assistant | MN | |
| Physician Assistant | IL | |
| Physician Assistant | MN | |
| Physician Assistant | MN | |
| Internal Medicine | MN | |
| Nurse Practitioner | MN |
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