Individual provider Active NPI

Ruby Kaur Gill, M.D

  • Family Medicine Physician
  • Lodi, CA
National Provider Identifier
1609147354
Registry record updated Mar 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A131215 Issued in CA
Practice address
999 S Fairmont Ave Ste 235
Lodi, CA 95240-5100
Phone
(209) 334-0799
NPI assigned
Jan 25, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A131215 CA Primary

Addresses

Primary practice location

999 S Fairmont Ave Ste 235
Lodi, CA 95240-5100

Mailing address

PO Box 2597
Lodi, CA 95241-2597
Phone (209) 334-0799

Other practice location 1

1901 W Kettleman Ln
Suite 200
Lodi, CA 95242-4337
Phone (209) 334-8540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20151222000793 CA Practitioner - Family Practice 6507184488 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A131215CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lodi Memorial Hospital Association, Inc CurrentSince Apr 1, 2017 Accepting new patients
Gill Medical Group, Inc. Family Medicine CurrentSince Jan 8, 2018 Accepting new patients
Lodi Memorial Hospital Association Inc CurrentSince Apr 1, 2017 Accepting new patients

Locations

2415 W Vine St
Ste 105
Lodi, CA 95242
Phone (209) 333-3121

999 S Fairmont Ave
Ste 235
Lodi, CA 95240
Phone (209) 334-0799

1901 W Kettleman Ln
Ste 200
Lodi, CA 95242
Phone (209) 334-8540

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1327449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522022400000",
    "number": "1609147354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2597",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952412597",
            "telephone_number": "209-334-0799",
            "fax_number": "209-334-5007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 S FAIRMONT AVE STE 235",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405100",
            "telephone_number": "209-334-0799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 W Kettleman Ln",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Lodi",
            "state": "CA",
            "postal_code": "952424337",
            "country_code": "US",
            "telephone_number": "209-334-8540",
            "fax_number": "209-368-2885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILL",
        "first_name": "RUBY",
        "middle_name": "KAUR",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-25",
        "last_updated": "2018-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A131215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.