Individual provider Active NPI

Richard J Kolodrubetz, MD

  • Family Medicine Physician
  • Ellicott City, MD
National Provider Identifier
1619083508
Registry record updated Sep 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0031575 Issued in MD
Practice address
9501 Old Annapolis Road
Suite 308
Ellicott City, MD 21042
Phone
(301) 621-6570
Fax
(301) 621-6589
NPI assigned
Aug 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2016

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 D0031575 MD Primary

Addresses

Primary practice location

9501 Old Annapolis Road
Suite 308
Ellicott City, MD 21042

Mailing address

9501 Old Annapolis Road
Suite 308
Ellicott City, MD 21042
Phone (301) 621-6570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20100914000941 MD Practitioner - Family PracticePractitioner - Geriatric Medicine 1557355922 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
University of Maryland School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

9501 Old Annapolis Rd
Suite 220
Ellicott City, MD 21042-6332
Phone (410) 772-2000

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0031575MDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Oct 6, 2015 Accepting new patients
Medstar Medical Group II LLC CurrentSince Oct 6, 2015 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

9501 Old Annapolis Rd
Ste 220
Ellicott City, MD 21042
Phone (410) 772-2000

9501 Old Annapolis Rd
Ste 308
Ellicott City, MD 21042
Phone (301) 621-6570

1406 Crain Hwy S
Glen Burnie, MD 21061
Phone (410) 768-6440

1406 Crain Hwy S
Ste 106
Glen Burnie, MD 21061
Phone (410) 768-6440

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": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473206400000",
    "number": "1619083508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9501 OLD ANNAPOLIS ROAD",
            "address_2": "SUITE 308",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "21042",
            "telephone_number": "301-621-6570",
            "fax_number": "301-621-6589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9501 OLD ANNAPOLIS ROAD",
            "address_2": "SUITE 308",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "21042",
            "telephone_number": "301-621-6570",
            "fax_number": "301-621-6589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLODRUBETZ",
        "first_name": "RICHARD",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2016-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0031575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

Verify at the official NPI Registry.