NPIMap

Individual provider Active NPI

Adam D Rubin, MD

  • Otolaryngology Physician
  • Saint Clair Shores, MI
National Provider Identifier
1568554087
Registry record updated Oct 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
AR072598 Issued in MI
Practice address
21000 E 12 Mile Rd
Suite 111
Saint Clair Shores, MI 48081-1116
Phone
(586) 779-7610
NPI assigned
Sep 29, 2006
Last updated
Oct 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X AR072598 MI Primary

Addresses

Primary practice location

21000 E 12 Mile Rd
Suite 111
Saint Clair Shores, MI 48081-1116

Mailing address

21000 E 12 Mile Rd
Ste 111
St Clair Shores, MI 48081
Phone (586) 779-7310

Other identifiers 9

IdentifierTypeStateIssuer
I18665OtherHEALTH ALLIANCE PLAN
0501549OtherBLUE CARE NETWORK
139782OtherCARE CHOICES
16768OtherMCAR
4635114MedicaidMI
7234039OtherCIGNA
0405015491OtherBLUE CROSS BLUE SHIELD
7883549OtherAETNA
P00217135OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20041020001264 MI Practitioner - Otolaryngology 0941261200 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Harvard Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

21000 E 12 Mile Rd
Suite 111
Saint Clair Shores, MI 48081-1156
Phone (586) 779-7610

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
AR072598MIMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital CurrentSince Dec 20, 2011 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Dec 20, 2011 Accepting new patients
Lakeshore Ear Nose and Throat Center PC Otolaryngology Past Accepting new patients
Henry Ford Health St. John Hospital Past Accepting new patients

Locations

43750 Garfield Rd
Ste 101
Clinton Twp, MI 48038
Phone (586) 263-7400

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

17770 Mack Ave
Grosse Pointe Shores, MI 48230
Phone (313) 882-1731

17900 23 Mile Rd
Ste 203
Macomb, MI 48044
Phone (586) 263-7400

21000 E 12 Mile Rd
Ste 111
St Clr Shores, MI 48081
Phone (586) 779-7610

Interoperability endpoints

  • Direct secure messaging: adam.rubin.1@17789.direct.athenahealth.com
  • Direct secure messaging: arubin57065@direct.hfhs.org

Organizations & group practices 5

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 9

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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191888000000",
    "number": "1568554087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21000 E 12 MILE RD",
            "address_2": "STE 111",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "48081",
            "telephone_number": "586-779-7310",
            "fax_number": "586-445-2523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21000 E 12 MILE RD",
            "address_2": "SUITE 111",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811116",
            "telephone_number": "586-779-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBIN",
        "first_name": "ADAM",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2007-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MI",
            "license": "AR072598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PLAN",
            "identifier": "I18665",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "0501549",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "139782",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCAR",
            "identifier": "16768",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4635114",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7234039",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0405015491",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7883549",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00217135",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.