Active NPI
Mark S Rybczynski, D.O.
- Family Medicine Physician
- St John, IN
National Provider Identifier
1124113386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 02001056A
- Practice address
- 9495 Keilman Avenue
Suite 3 and 4
St John, IN 46373-9295 - Phone
- (219) 365-7000
- Fax
- (219) 365-2609
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 02001056A | IN | Primary |
Addresses
Primary practice location
9495 Keilman Avenue
Suite 3 and 4
St John, IN 46373-9295
Mailing address
1040 Sierra Dr
Ste 400
Greenwood, IN 46143-7240
Phone (317) 528-4800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0090000854 | Other | IL | BCBS GROUP NUMBER |
| 10021550 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02001056A | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| St Margaret Mercy Healthcare Centers | Family Medicine | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Saint John, IN
- NPI 1659448314
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324425600000",
"number": "1124113386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1040 SIERRA DR",
"address_2": "STE 400",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461437240",
"telephone_number": "317-528-4800",
"fax_number": "317-865-1479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9495 KEILMAN AVENUE",
"address_2": "SUITE 3 AND 4",
"city": "ST JOHN",
"state": "IN",
"postal_code": "463739295",
"telephone_number": "219-365-7000",
"fax_number": "219-365-2609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYBCZYNSKI",
"first_name": "MARK",
"middle_name": "S",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2011-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "02001056A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS GROUP NUMBER",
"identifier": "0090000854",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10021550",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in St John, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.