Individual provider Active NPI

Isadore L Rubin, MD

  • Developmental - Behavioral Pediatrics Physician
  • Atlanta, GA
National Provider Identifier
1710987920
Registry record updated Jul 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
039221 Issued in GA
Practice address
35 Jesse Hill Jr Dr SE
Hughes Spalding Childrens Hospital
Atlanta, GA 30303-3032
Phone
(404) 616-4878
Fax
(404) 616-2416
NPI assigned
Jul 29, 2005
Last updated
Jul 7, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 039221 GA
Developmental - Behavioral Pediatrics Physician 2080P0006X 039221 GA Primary

Addresses

Primary practice location

35 Jesse Hill Jr Dr SE
Hughes Spalding Childrens Hospital
Atlanta, GA 30303-3032

Mailing address

75 Piedmont Ave
Ste 700
Atlanta, GA 30303-2544
Phone (404) 756-1410

Other identifiers 1

IdentifierTypeStateIssuer
000624412MedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20041027000008 GA Practitioner - Pediatric Medicine 2961481809 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
039221GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Emory Clinic Inc CurrentSince May 1, 2015 Accepting new patients
Morehouse Healthcare, Inc. Pediatrics CurrentSince Sep 1, 2004 Accepting new patients
The Emory Clinic Pediatric Providers Past Accepting new patients
Team Centers Inc Past Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

35 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 785-9500

75 Piedmont Ave NE
Ste 700
Atlanta, GA 30303
Phone (404) 756-1410

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

1595 Cleveland Ave
East Point, GA 30344
Phone (404) 305-8086

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215388800000",
    "number": "1710987920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 PIEDMONT AVE",
            "address_2": "STE 700",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303032544",
            "telephone_number": "404-756-1410",
            "fax_number": "404-756-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 JESSE HILL JR DR SE",
            "address_2": "HUGHES SPALDING CHILDRENS HOSPITAL",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303033032",
            "telephone_number": "404-616-4878",
            "fax_number": "404-616-2416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBIN",
        "first_name": "ISADORE",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2008-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "039221",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "GA",
            "license": "039221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000624412",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.