Individual provider Active NPI

Jessica L Rubashkin, CPNP

  • Pediatric Nurse Practitioner
  • Waterville, ME
National Provider Identifier
1083843023
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
CNP91036 Issued in ME
Practice address
159 Silver St
Waterville, ME 04901-5813
Phone
(207) 873-5437
Fax
(207) 861-5448
NPI assigned
Jul 13, 2009
Last updated
Apr 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X CNP91036 ME Primary

Addresses

Primary practice location

159 Silver St
Waterville, ME 04901-5813

Mailing address

159 Silver St
Waterville, ME 04901-5813
Phone (207) 873-5437

Other identifiers 1

IdentifierTypeStateIssuer
434241099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240920002384 ME Practitioner - Nurse Practitioner 0345781001 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mainegeneral Medical Center CurrentSince Aug 26, 2024 Accepting new patients
Mainegeneral Medical Center CurrentSince Aug 26, 2024 Accepting new patients
Waterville Pediatrics PA Past Accepting new patients

Locations

149 North St
Waterville, ME 04901
Phone (207) 622-1959

295C Kennedy Memorial Dr
Ste 1
Waterville, ME 04901
Phone (207) 873-5437

Interoperability endpoints

  • Direct secure messaging: jessicarubashkin@mgh.allscriptsdirect.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1083843023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 SILVER ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049015813",
            "telephone_number": "207-873-5437",
            "fax_number": "207-861-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 SILVER ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049015813",
            "telephone_number": "207-873-5437",
            "fax_number": "207-861-5448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBASHKIN",
        "first_name": "JESSICA",
        "middle_name": "L",
        "credential": "CPNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-13",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "ME",
            "license": "CNP91036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "434241099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterville, ME

Sources for this page

Verify at the official NPI Registry.