Individual provider Active NPI

Bruce Kalman Rubin, MD, MENGR, MBA

  • Pediatric Pulmonology Physician
  • Richmond, VA
National Provider Identifier
1235113317
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
License
0101246124 Issued in VA
Practice address
1000 E Broad St
Richmond, VA 23219-1930
Phone
(804) 828-2467
Fax
(804) 828-9439
NPI assigned
Dec 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Pulmonology Physician 2080P0214X 9701576 NC
Pediatric Pulmonology Physician 2080P0214X 0101246124 VA Primary

Addresses

Primary practice location

1000 E Broad St
Richmond, VA 23219-1930

Mailing address

PO Box 780125
Philadelphia, PA 19178-0125
Phone (804) 922-4844

Other practice location 1

1250 E Marshall St
Richmond, VA 23298-5023
Phone (804) 828-2467

Other practice location 2

1200 E Marshall St
Richmond, VA 23298-5023
Phone (804) 828-2467

Other identifiers 9

IdentifierTypeStateIssuer
891093TMedicaidNC
Q0157CMedicaidSC
6729738MedicaidVA
7556338OtherAETNA
1093TOtherBCBS
17762OtherPARTNERS
76111OtherMEDCOST
220407000MedicaidWV
370020986OtherRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, OH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090828000556 VA Practitioner - Pediatric MedicinePractitioner - Pulmonary Disease 2163405820 Reassigns benefits to 1 organization
I20250514003672 OH Practitioner - Pediatric MedicinePractitioner - Pulmonary Disease 2163405820 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
University Hospitals Medical Group Inc CurrentSince May 1, 2025 Accepting new patients
MCV Associated Physicians CurrentSince Jul 12, 2009 Accepting new patients
Multicare Health System Past Accepting new patients
University Hospitals Cleveland Medical Center Past Accepting new patients

Locations

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

8055 Mayfield Rd
Ste 105
Chesterland, OH 44026
Phone (440) 214-8024

11100 Euclid Ave
Fl Hhvi
Cleveland, OH 44106

11100 Euclid Ave
Cleveland Heights, OH 44106

1200 E Marshall St
Richmond, VA 23298
Phone (804) 827-0561

1001 E Marshall St
#980646
Richmond, VA 23298

1001 E Marshall St
Richmond, VA 23298
Phone (804) 828-0099

1000 E Broad St
Richmond, VA 23219

1250 E Marshall St
Richmond, VA 23298
Phone (804) 628-6990

401 N 11th St
Richmond, VA 23219
Phone (804) 828-4409

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718064000000",
    "number": "1235113317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 780125",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191780125",
            "telephone_number": "804-922-4844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E BROAD ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232191930",
            "telephone_number": "804-828-2467",
            "fax_number": "804-828-9439"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1250 E Marshall St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232985023",
            "country_code": "US",
            "telephone_number": "804-828-2467",
            "fax_number": "804-828-9429",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 E Marshall St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232985023",
            "country_code": "US",
            "telephone_number": "804-828-2467",
            "fax_number": "804-828-9439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUBIN",
        "first_name": "BRUCE",
        "middle_name": "KALMAN",
        "credential": "MD, MENGR, MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-02",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "NC",
            "license": "9701576",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "VA",
            "license": "0101246124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891093T",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q0157C",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6729738",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7556338",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1093T",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "17762",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "76111",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220407000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "370020986",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.