Jay Kenneth Brubaker, M.D.

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

MD012919E Issued in PA

Practice address

2110 Harrisburg Pike
Suite 300
Lancaster, PA 17604-3200

Phone

(717) 544-3022

Fax

(717) 544-3021

NPI assigned

Jan 23, 2006

Last updated

Mar 30, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301443200000",
    "number": "1063482172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 HARRISBURG PIKE",
            "address_2": "SUITE 300",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176043200",
            "telephone_number": "717-544-3022",
            "fax_number": "717-544-3021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 HARRISBURG PIKE",
            "address_2": "SUITE 300",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176043200",
            "telephone_number": "717-544-3022",
            "fax_number": "717-544-3021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUBAKER",
        "first_name": "JAY",
        "middle_name": "KENNETH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2011-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "PA",
            "license": "MD012919E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006876040001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006876040002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "127131",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON-HMO",
            "identifier": "4662910",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006876040004",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "516348",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000687604",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "01350102",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN",
            "identifier": "20011 S101",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY HEALTH PLAN",
            "identifier": "P002665",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia Brubaker, PAC
• Derek Glenn Brubaker
• Derick S Brubaker, M.D.
• Devon Elizabeth Brubaker, ATC
• Glen Roy Brubaker, M.D.
• Jennifer E Brubaker, M.D.
• Joellyn Elizabeth Brubaker, PTA
• Mark Brubaker
• Rachel Lynn Brubaker, LMT
• Bruce Eyer LLC

• Geriatric Medicine (Family Medicine) Physician in Lancaster, PA
• Providers in Lancaster, PA by specialty
• Geriatric Medicine (Family Medicine) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.