Individual provider Active NPI

Mitzi B. Rubin, M.D.

  • Family Medicine Physician
  • Marietta, GA
National Provider Identifier
1154403582
Registry record updated Nov 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
049592 Issued in GA
Practice address
55 Whitcher St NE Ste 400
Marietta, GA 30060-1129
Phone
(470) 956-3960
Fax
(770) 590-3710
NPI assigned
Oct 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obesity Medicine (Family Medicine) Physician 207QB0002X 49592 GA
Family Medicine Physician 207Q00000X 049592 GA Primary

Addresses

Primary practice location

55 Whitcher St NE Ste 400
Marietta, GA 30060-1129

Mailing address

55 Whitcher St NE Ste 400
Marietta, GA 30060-1129
Phone (470) 956-3960

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100810000434 GA Practitioner - Family Practice 1153455365 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Chicago College of Medicine and Surgery, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

3052 Shallowford Rd
Suite 100
Marietta, GA 30062-1252
Phone (770) 240-0923

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

55 Whitcher Nest
Marietta, GA 30060-1129

55 Whitcher St
Marietta, GA 30060-1129

55 Whitcher St NE
Suite 400
Marietta, GA 30060-1129
Phone (470) 956-3960

587 Furys Ferry Rd
Martinez, GA 30907-9059
Phone (706) 721-8623

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
049592GAMDFamily Medicine Physician
49592GAMDObesity Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Jan 1, 2011 Accepting new patients
Kennesaw Family Physicians PC Family Medicine Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Jan 1, 2011 Accepting new patients
Wellstar Medical Group, LLC Family Medicine Current Accepting new patients
Wellstar Cardiovascular Medicine, LLC Past Accepting new patients

Locations

4791 S Main St
Acworth, GA 30101
Phone (770) 422-1400

1700 Hospital South Dr
Ste 202
Austell, GA 30106
Phone (770) 793-7440

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

55 Whitcher St NE
Ste 400
Marietta, GA 30060
Phone (470) 956-3960

677 Church St NE
Marietta, GA 30060
Phone (770) 793-5435

3939 Roswell Rd
Ste 200
Marietta, GA 30062
Phone (470) 956-3940

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

3747 Roswell Rd
Ste 216
Marietta, GA 30062
Phone (770) 973-2272

Interoperability endpoints

  • Direct secure messaging: mrubin25863@directwellstar.org

Organizations & group practices 5

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 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1154403582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE STE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601129",
            "telephone_number": "470-956-3960",
            "fax_number": "770-590-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE STE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601129",
            "telephone_number": "470-956-3960",
            "fax_number": "770-590-3710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBIN",
        "first_name": "MITZI",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QB0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "GA",
            "license": "49592",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "049592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.