Jon Elliott Dale Brubaker, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036.165622 Issued in IL

Practice address

310 W Losey St
Scott AFB, IL 62225-5250

Phone

(618) 256-9355

Fax

(618) 256-7629

NPI assigned

Jan 20, 2020

Last updated

Jul 26, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Internal Medicine

Education

Creighton University School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Illinois Healthcare Foundation IncGroup PAC ID 1456256874, 117 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HSHS St Elizabeth's Hospital Hospital, O Fallon, IL, CCN 140187

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jon.brubaker.1@9559.direct.athenahealth.com

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.

• Southern Illinois Healthcare Foundation Inc

  dba Centreville Health Center

  • Federally Qualified Health Center (FQHC)
  • Centreville, IL
  • NPI 1609813500

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Southern Illinois Healthcare Foundation Inc

  dba SIHF Healthcare

  • Federally Qualified Health Center (FQHC)
  • Arthur, IL
  • NPI 1508301706

  Internal Medicine

  NPD
• Southern Illinois Healthcare Foundation Inc

  dba SIHF Healthcare

  • Federally Qualified Health Center (FQHC)
  • Waterloo, IL
  • NPI 1821813247
  NPD

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

• St Elizabeths Hospital of the Hospital Sisters of the Third Order

  dba HSHS St. Elizabeth's Hospital

  • General Acute Care Hospital
  • O'Fallon, IL
  • NPI 1629057302
  Care Compare affiliation

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

{
    "created_epoch": "1579478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721952000000",
    "number": "1265062178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-9355",
            "fax_number": "618-256-7629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-9355",
            "fax_number": "618-256-7629"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Saint Elizabeth Blvd Ste 4000",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "IL",
            "postal_code": "622691284",
            "country_code": "US",
            "telephone_number": "618-233-5480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUBAKER",
        "first_name": "JON ELLIOTT",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-20",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036.165622",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.165622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Ruth Bergmann, PSYD, LPC
• Angelic Berry, M.ED, M.S.
• Susannah Frances Bouchard, WHNP
• David Brown, BSN
• Todd Richard Broyles, D.D.S.
• Trevor Todd Brue, DO
• Darlene Ruth Brunner, WOMEN'S HEALTH NP
• Jake Douglas Brush, DDS
• Christine Marie Bucher, RNC
• Leslie A Buck, PH.D (ABD)

• Internal Medicine Physician in Scott AFB, IL
• Providers in Scott AFB, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; 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.

Verify at the official NPI Registry.