Individual provider Active NPI

Adam Paul Rubin, O.D.

  • Optometrist
  • Gaithersburg, MD
National Provider Identifier
1477607885
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA1638 Issued in MD
Practice address
18310 Montgomery Village Ave Ste 140
Gaithersburg, MD 20879-3556
Phone
(301) 869-4070
Fax
(301) 869-0397
NPI assigned
Jan 22, 2007
Last updated
Sep 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TA1638 MD Primary

Addresses

Primary practice location

18310 Montgomery Village Ave Ste 140
Gaithersburg, MD 20879-3556

Mailing address

18310 Montgomery Village Ave Ste 140
Gaithersburg, MD 20879-3556
Phone (301) 869-4070

Other identifiers 1

IdentifierTypeStateIssuer
1M6012OtherMDPTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050303000699 DC Practitioner - Optometry 7113970112 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aeg Maryland Professional LLCGroup PAC ID 7618316902, 20 clinicians

Practice addresses (Care Compare)

18310 Montgomery Village Ave
Suite 140
Gaithersburg, MD 20879-3556
Phone (301) 869-4070

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TA1638MDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Montgomery Village Eye Center Inc Optometrist CurrentSince Feb 22, 2021 Accepting new patients
Aeg Maryland Professional LLC Optometrist CurrentSince Dec 25, 2023 Accepting new patients

Locations

111 E 4th St
Ste 440
Alton, IL 62002

18310 Montgomery Village Ave
Ste 140
Gaithersburg, MD 20879
Phone (301) 698-4070

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.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1477607885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18310 MONTGOMERY VILLAGE AVE STE 140",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793556",
            "telephone_number": "301-869-4070",
            "fax_number": "301-869-0397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18310 MONTGOMERY VILLAGE AVE STE 140",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793556",
            "telephone_number": "301-869-4070",
            "fax_number": "301-869-0397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBIN",
        "first_name": "ADAM",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "1M6012",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

Verify at the official NPI Registry.