Active NPI
Jack Rubin M D a Professional Corporation
- Nephrology Physician
- Long Beach, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- Legal business name
- JACK RUBIN M D A PROFESSIONAL CORPORATION
- Practice address
- 1045 Atlantic Ave
Suite 915
Long Beach, CA 90813-3408 - Phone
- (562) 596-1667
- NPI assigned
- Sep 20, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jack Rubin, MD
- Title
- Owner
- Phone
- (562) 299-5239
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | Primary |
Addresses
Primary practice location
1045 Atlantic Ave
Suite 915
Long Beach, CA 90813-3408
Mailing address
PO Box 1127
Los Alamitos, CA 90720-1127
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0084691 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Jack Rubin MD
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Nephrology Physician
- Los Alamitos, CA
- NPI 1215129523
Member organizations 1
Organizations listed as members of this organization in the National Provider Directory.
Locations
2683 Pacific Ave
Ste B
Long Beach, CA 90806
Phone (562) 997-2156
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190246400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1449619200000",
"number": "1144416348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1127",
"city": "LOS ALAMITOS",
"state": "CA",
"postal_code": "907201127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1045 ATLANTIC AVE",
"address_2": "SUITE 915",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908133408",
"telephone_number": "562-596-1667"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JACK RUBIN M D A PROFESSIONAL CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2007-09-20",
"last_updated": "2015-12-09",
"status": "A",
"authorized_official_last_name": "RUBIN",
"authorized_official_first_name": "JACK",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "562-299-5239",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0084691",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.