Active NPI
Roel Nolido Querubin, M.D.
- Rheumatology Physician
- Marietta, GA
National Provider Identifier
1124154323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 43112
- Practice address
- Marietta Rheumatology Associates
670 North Avenue Suite 100
Marietta, GA 30060 - Phone
- (770) 560-7166
- Fax
- (770) 727-2121
- NPI assigned
- Feb 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | 043112 | GA | |
| Rheumatology Physician | 207RR0500X | 43112 | GA | Primary |
Addresses
Primary practice location
Marietta Rheumatology Associates
670 North Avenue Suite 100
Marietta, GA 30060
Mailing address
670 North Avenue
Suite 300
Marietta, GA 30060
Phone (770) 560-7166
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 690710060A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040917000144 | GA | Practitioner - Rheumatology | 1658348768 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Rheumatology
- Education
- Medical College of Georgia School of Medicine, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Marietta Rheumatology Associates, P.C.
Practice addresses (Care Compare)
670 N Ave NW
Suite 100
Marietta, GA 30060-1100
Phone (770) 590-8328
Hospital & facility affiliations
- Wellstar Kennestone Regional Medical Center
- Wellstar Cobb Medical Center
- Wellstar Paulding Medical Center
- Wellstar Windy Hill Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43112 | GA | MD | Rheumatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marietta Rheumatology Associates, P.C. | Current | Accepting new patients | |
| Rheumatology of North Atlanta | Rheumatology | Past | Accepting new patients |
Locations
670 North Ave NW
Ste 300
Marietta, GA 30060
670 North Ave NW
Ste A
Marietta, GA 30060
Phone (770) 590-8328
670 North Ave NW
Ste 100
Marietta, GA 30060
Phone (770) 560-7166
Interoperability endpoints
- roel.querubin@mra.eclinicaldirectplus.com
- https://fhir4.healow.com/fhir/r4/DAIDAA/Endpoint/DAIDAA
- https://fhir4.healow.com/fhir/r4/DAIDAA
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.
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Long Term Care Hospital
- Marietta, GA
- NPI 1700853041
Long-term care hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657065600000",
"number": "1124154323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 NORTH AVENUE",
"address_2": "SUITE 300",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30060",
"telephone_number": "770-560-7166",
"fax_number": "770-727-2121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MARIETTA RHEUMATOLOGY ASSOCIATES",
"address_2": "670 NORTH AVENUE SUITE 100",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30060",
"telephone_number": "770-560-7166",
"fax_number": "770-727-2121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUERUBIN",
"first_name": "ROEL",
"middle_name": "NOLIDO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-24",
"last_updated": "2022-07-06",
"certification_date": "2022-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "GA",
"license": "043112",
"primary": false
},
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "GA",
"license": "43112",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "690710060A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.