Active NPI
Raymond L Ruberg, D.O.
- Family Medicine Physician
- Codorus, PA
National Provider Identifier
1508806175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS004031L
- Practice address
- 36 Hanover Street
Codorus, PA 17311-0128 - Phone
- (717) 229-2972
- Fax
- (717) 229-0542
- NPI assigned
- Jun 8, 2006
- Last updated
- Nov 1, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS004031L | PA | Primary |
Addresses
Primary practice location
36 Hanover Street
Codorus, PA 17311-0128
Mailing address
PO Box 128
36 Hanover Street
Codorus, PA 17311-0128
Phone (717) 229-2972
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005714300001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111229000469 | PA | Practitioner - Family Practice | 7911173661 | Practice locations: Codorus, PA |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Philadelphia College of Osteopathic Medicine, 1978
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
36 Hanover St
Codorus, PA 17311-0128
Phone (717) 229-2972
PO Box
Suite 128
Codorus, PA 17311-0128
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS004031L | PA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/DFHBBA/Endpoint/DFHBBA
Organizations & group practices 1
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.
-
dba Frederick Health Hospital
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba WellSpan Gettysburg Hospital SPU
- Ambulatory Surgical Clinic/Center
- Gettysburg, PA
- NPI 1184882011
Hospital
-
- General Acute Care Hospital
- Gettysburg, PA
- NPI 1265466957
-
- General Acute Care Hospital
- Hanover, PA
- NPI 1730158981
-
- General Acute Care Hospital
- York, PA
- NPI 1326060492
-
dba York Hospital Community Health Center
- Clinic/Center
- York, PA
- NPI 1497814040
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320105600000",
"number": "1508806175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 128",
"address_2": "36 HANOVER STREET",
"city": "CODORUS",
"state": "PA",
"postal_code": "173110128",
"telephone_number": "717-229-2972",
"fax_number": "717-229-0542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 HANOVER STREET",
"city": "CODORUS",
"state": "PA",
"postal_code": "173110128",
"telephone_number": "717-229-2972",
"fax_number": "717-229-0542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUBERG",
"first_name": "RAYMOND",
"middle_name": "L",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-08",
"last_updated": "2011-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "OS004031L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0005714300001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; 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.