Rod Stephen Kubley, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01035442 Issued in IN

Practice address

1919 Lake Ave
Suite 104
Plymouth, IN 46563-7830

Phone

(574) 941-2929

Fax

(574) 941-3008

NPI assigned

Jun 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Saint Joseph Regional Medical Center- Plymouth Campus Inc

  • Family Medicine Physician
  • Plymouth, IN
  • NPI 1538585187

  Family Medicine

  NPD (past)
• Saint Joseph Regional Medical Center, Inc.

  • Pulmonary Disease Physician
  • Plymouth, IN
  • NPI 1225082878
  NPD (past)
• South Bend Psychiatry LLC

  • Psychiatry Physician
  • Plymouth, IN
  • NPI 1700112224
  NPD (past)

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1821037532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 E CEDAR ST",
            "address_2": "STE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172057",
            "telephone_number": "574-335-8700",
            "fax_number": "574-335-0760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 LAKE AVE",
            "address_2": "SUITE 104",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465637830",
            "telephone_number": "574-941-2929",
            "fax_number": "574-941-3008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBLEY",
        "first_name": "ROD",
        "middle_name": "STEPHEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01035442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG PIN",
            "identifier": "021236800",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100173750B",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000216243",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rod.kubley@directsjpn.mhin.net",
            "affiliation": "N",
            "endpointDescription": "SJRMC direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2349 Lake Ave Ste 100",
            "city": "Plymouth",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465637836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Grant Nicholas Kolbe, MSED
• Jerry Kralovansky, O.D.
• Lindsay McKay Kreps, NP-C
• David John Krizman, M.D.
• Kroger Limited Partnership I
• Brooke Nikole Kuhn, BCBA
• Michele Rene Kyser-Lafree, OTR
• Lafree Orthopedic & Sports Physical Therapy PC
• Lafree Physical Therapy
• John Edward Lafree, PT ATC

• All providers in Plymouth, IN
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; 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.