NPIMap

Individual provider Active NPI

Susan Mara Rubin

  • Physician Assistant
  • East Stroudsburg, PA
National Provider Identifier
1275046112
Registry record updated Nov 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA-002863-L Issued in PA
Practice address
600 Plaza CT
East Stroudsburg, PA 18301-8263
Phone
(570) 421-7020
Fax
(570) 421-7091
NPI assigned
Nov 14, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA-002863-L PA Primary

Addresses

Primary practice location

600 Plaza CT
East Stroudsburg, PA 18301-8263

Mailing address

600 Plaza CT
East Stroudsburg, PA 18301-8263

Other identifiers 1

IdentifierTypeStateIssuer
223102230OtherPANONE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20180109002821 PA Practitioner - Physician Assistant 0143589614 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain Valley Orthopedics PCGroup PAC ID 6901899111, 20 clinicians

Practice addresses (Care Compare)

120 Burrus Blvd
Suite 120
Brodheadsville, PA 18322-7812
Phone (570) 421-7020

600 Plaza CT
Suite C
East Stroudsburg, PA 18301-8263
Phone (570) 421-7020

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA-002863-LPAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Valley Orthopedics PC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9299/brand/1/csg/1/fhir/r4
  • Direct secure messaging: susan.rubin.1@9299.direct.athenahealth.com

Organizations & group practices 2

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 10

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": "1510617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510617600000",
    "number": "1275046112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 PLAZA CT",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183018263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PLAZA CT",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183018263",
            "telephone_number": "570-421-7020",
            "fax_number": "570-421-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBIN",
        "first_name": "SUSAN",
        "middle_name": "MARA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-14",
        "last_updated": "2017-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA-002863-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "223102230",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Stroudsburg, PA

Sources for this page

Verify at the official NPI Registry.