NPIMap

Individual provider Active NPI

Rodney T. Rubi, MD

  • Internal Medicine Physician
  • Ellington, MO
National Provider Identifier
1184727422
Registry record updated Jun 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
117506 Issued in MO
Practice address
205 Walnut St.
Ellington, MO 63638-0157
Phone
(573) 663-2525
Fax
(573) 663-7821
NPI assigned
Sep 5, 2006
Last updated
Jun 4, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 117506 MO Primary

Addresses

Primary practice location

205 Walnut St.
Ellington, MO 63638-0157

Mailing address

PO Box 249
Ellington, MO 63638-0249
Phone (573) 785-3984

Other identifiers 8

IdentifierTypeStateIssuer
04-01123OtherMOUNITED HEALTH CARE
04-01124OtherMOUNITED HEALTHCARE
04-01126OtherMOUNITED HEALTH CARE
04-03473OtherMOUNITED HEALTH CARE
1184727422OtherRAILROAD MEDICARE
204018402MedicaidMO
418570OtherMOHEALTHLINK
127515OtherMOBLUE CROSS/BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100105000725 MO Practitioner - Internal MedicinePractitioner - Family Practice 8527109081 Reassigns benefits to 1 organization
Practice locations: Ellington, MO; Van Buren, MO

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dexter Hospital, LLCGroup PAC ID 6507834579, 16 clinicians

Practice addresses (Care Compare)

1200 N One Mile Rd
Dexter, MO 63841-1000

1300 N One Mile
Suite 3
Dexter, MO 63841-1000

2002 Kanell Blvd
Suite 101
Poplar Bluff, MO 63901-4011
Phone (573) 614-1900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
70.1 of 100Reported as group
Quality
41.46
Improvement activities
40
Cost
87.48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
117506MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Health Center of Stoddard County, LLC CurrentSince Apr 1, 2020 Accepting new patients
Southeast Health Center of Stoddard County LLC Internal Medicine CurrentSince Apr 1, 2020 Accepting new patients
Southeast Health Center of Stoddard County, LLC Current Accepting new patients
Ellington 1 Inc PastSince Jan 1, 2020 Accepting new patients
Ozarks Medical Center Past Accepting new patients
Van Buren No1 Inc Past Accepting new patients
Big Springs Medical Association Past Accepting new patients

Locations

1200 N One Mile Rd
Dexter, MO 63841
Phone (573) 614-1900

2002 Kanell Blvd
Ste 101
Poplar Bluff, MO 63901
Phone (573) 614-1900

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Riverways ManorVan Buren, MO, CCN 265363 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2017
May 1, 2017
Brent B Tinnin ManorEllington, MO, CCN 265472 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2020
Jan 1, 2020

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Ellington 1 Inc

    dba Brent B Tinnin Manor

    • Skilled Nursing Facility
    • Ellington, MO
    • NPI 1629000690

    Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • Van Buren No1 Inc

    dba Riverways Manor

    • Skilled Nursing Facility
    • Van Buren, MO
    • NPI 1881626836

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

Organizations & group practices 7

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

Hospital & facility affiliations 6

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": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212537600000",
    "number": "1184727422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "ELLINGTON",
            "state": "MO",
            "postal_code": "636380249",
            "telephone_number": "573-785-3984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 WALNUT ST.",
            "city": "ELLINGTON",
            "state": "MO",
            "postal_code": "636380157",
            "telephone_number": "573-663-2525",
            "fax_number": "573-663-7821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBI",
        "first_name": "RODNEY",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2008-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "117506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "04-01123",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "04-01124",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "04-01126",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "04-03473",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "1184727422",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204018402",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "418570",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "127515",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellington, MO

Sources for this page

Verify at the official NPI Registry.