Individual provider Active NPI

Maria Susan Rubino, ANP

  • Adult Health Nurse Practitioner
  • Port Jefferson, NY
National Provider Identifier
1760994248
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
308368 Issued in NY
Practice address
75 N Country Rd
Port Jefferson, NY 11777-2119
Phone
(631) 473-1320
NPI assigned
Oct 24, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 308368 NY Primary

Addresses

Primary practice location

75 N Country Rd
Port Jefferson, NY 11777-2119

Mailing address

67 N Country Rd
Miller Place, NY 11764-1406
Phone (631) 697-0497

Other practice location 1

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (631) 642-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180118001323 NY Practitioner - Nurse Practitioner 6800155912 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of New York at Stony Brook, School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
John T Mather Memorial HospitalGroup PAC ID 1254237753, shared by 6 NPIs, 176 clinicians

Practice addresses (Care Compare)

75 N Country Rd
Port Jefferson, NY 11777-2119
Phone (631) 473-1320

Hospital & facility affiliations

  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
308368NYMDSurgical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John T. Mather Memorial Hospital CurrentSince Mar 21, 2018 Accepting new patients
John T. Mather Memorial Hospital Current Accepting new patients
John T. Mather Memorial Hospital CurrentSince Mar 21, 2018 Accepting new patients
Good Shepherd Hospice CurrentSince Jul 23, 2018 Accepting new patients

Locations

110 Bi County Blvd
Ste 114
Farmingdale, NY 11735
Phone (631) 465-6300

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000

75 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 463-1320

50 Route 25A
Smithtown, NY 11787
Phone (631) 465-6225

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

  • Healthfirst Medicare Network H9678

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1508803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1760994248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 N COUNTRY RD",
            "city": "MILLER PLACE",
            "state": "NY",
            "postal_code": "117641406",
            "telephone_number": "631-697-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-473-1320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Belle Terre Rd",
            "address_purpose": "LOCATION",
            "city": "Port Jefferson",
            "state": "NY",
            "postal_code": "117771928",
            "country_code": "US",
            "telephone_number": "631-642-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUBINO",
        "first_name": "MARIA",
        "middle_name": "SUSAN",
        "name_prefix": "Ms.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "308368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.