Individual provider Active NPI

Mario Fernando Rubin, M.D.

  • Nephrology Physician
  • Baltimore, MD
National Provider Identifier
1710935044
Registry record updated Apr 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
D22617 Issued in MD
Practice address
22 S Greene St
Baltimore, MD 21201-1544
Phone
(410) 328-5720
Fax
(410) 328-5685
NPI assigned
May 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 50101 MA
Internal Medicine Physician 207R00000X 50101 MA
Nephrology Physician 207RN0300X D22617 MD Primary

Addresses

Primary practice location

22 S Greene St
Baltimore, MD 21201-1544

Mailing address

PO Box 64442
Baltimore, MD 21264-4442
Phone (410) 328-5720

Other identifiers 3

IdentifierTypeStateIssuer
S062-0568OtherMDCAREFIRST BC/BS
214128100MedicaidMD
6165524MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
50101MAMDInternal Medicine Physician
D22617MDMDNephrology Physician

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427846400000",
    "number": "1710935044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64442",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644442",
            "telephone_number": "410-328-5720",
            "fax_number": "410-328-5685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "410-328-5720",
            "fax_number": "410-328-5685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBIN",
        "first_name": "MARIO",
        "middle_name": "FERNANDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2015-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MA",
            "license": "50101",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "50101",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MD",
            "license": "D22617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC/BS",
            "identifier": "S062-0568",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214128100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6165524",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.