Advanced Dermatology Care Medical Cosmetic and Surgery PA
NPI 1073614558 · Dermatology Physician · White Bear Lake, MN
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Advanced Dermatology Care Medical Cosmetic and Surgery PA is a Dermatology Physician organization in White Bear Lake, MN (NPI 1073614558).
Provider details
- NPI number
- 1073614558
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Advanced Dermatology Care Medical and Surgical Dermatology PA
- Organization subpart
- Yes
- Authorized official
- Olaf Rustad, Owner(651) 484-2724
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Advanced Dermatology Care
- Doing business as
- Advanced Dermatology Care
Registry dates
- Enumerated
- 2006-09-26
- Last updated
- 2018-11-16
Frequently asked questions
- What is Advanced Dermatology Care Medical Cosmetic and Surgery PA's NPI number?
- Advanced Dermatology Care Medical Cosmetic and Surgery PA's National Provider Identifier (NPI) is 1073614558, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Advanced Dermatology Care Medical Cosmetic and Surgery PA?
- Advanced Dermatology Care Medical Cosmetic and Surgery PA is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is Advanced Dermatology Care Medical Cosmetic and Surgery PA located?
- Advanced Dermatology Care Medical Cosmetic and Surgery PA's practice location on file with NPPES is 4480 Centerville Rd, White Bear Lake, MN 55127-3674.
- What is Advanced Dermatology Care Medical Cosmetic and Surgery PA's phone number?
- The practice phone number listed in the NPPES registry for Advanced Dermatology Care Medical Cosmetic and Surgery PA is (651) 484-2724.
- Does Advanced Dermatology Care Medical Cosmetic and Surgery PA accept Medicare?
- Advanced Dermatology Care Medical Cosmetic and Surgery PA is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Advanced Dermatology Care Medical Cosmetic and Surgery PA?
- The authorized official listed on Advanced Dermatology Care Medical Cosmetic and Surgery PA's NPPES record is Olaf Rustad, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Advanced Dermatology Care Medical Cosmetic and Surgery PA's NPI active?
- Yes — Advanced Dermatology Care Medical Cosmetic and Surgery PA's NPI (1073614558) is active in the NPPES registry as of the last update on 2018-11-16.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.