Individual provider Active NPI

Michael De Rubeis, O.D.

  • Optometrist
  • Phoenix, AZ
National Provider Identifier
1124066394
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
AZ0591 Issued in AZ
Practice address
16515 S 40TH St
Suite 111
Phoenix, AZ 85048-0558
Phone
(480) 706-2020
Fax
(480) 759-0016
NPI assigned
Jun 2, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X AZ0591 AZ Primary

Addresses

Primary practice location

16515 S 40TH St
Suite 111
Phoenix, AZ 85048-0558

Mailing address

16515 S 40TH St
Suite 111
Phoenix, AZ 85048-0558
Phone (480) 706-2020

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051129000064 AZ Practitioner - Optometry 5991725517 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Eye Care Center of Ahwatukee PLCGroup PAC ID 1153732078, 2 clinicians

Practice addresses (Care Compare)

16515 S 40TH St
Suite 111
Phoenix, AZ 85048-0559
Phone (480) 706-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AZ0591AZMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Eye Care Center of Ahwatukee, PLC Optometrist CurrentSince Dec 1, 2020 Accepting new patients

Locations

16515 S 40th St
Ste 111
Phoenix, AZ 85048
Phone (480) 706-2020

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1124066394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16515 S 40TH ST",
            "address_2": "SUITE 111",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850480558",
            "telephone_number": "480-706-2020",
            "fax_number": "480-759-0016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16515 S 40TH ST",
            "address_2": "SUITE 111",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850480558",
            "telephone_number": "480-706-2020",
            "fax_number": "480-759-0016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE RUBEIS",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "AZ0591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.