NPIMap

Individual provider Active NPI

Stephen A Rubendall Jr., M.D.

  • Family Medicine Physician
  • Camilla, GA
National Provider Identifier
1851345284
Registry record updated Apr 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
057320 Issued in GA
Practice address
259 US Highway 19 North
Camilla, GA 31730-1410
Phone
(229) 336-1949
Fax
(229) 336-1436
NPI assigned
May 20, 2006
Last updated
Apr 10, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2019

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 057320 GA Primary

Addresses

Primary practice location

259 US Highway 19 North
Camilla, GA 31730-1410

Mailing address

259 US Highway 19 North
Camilla, GA 31730-1410
Phone (229) 336-1949

Other identifiers 2

IdentifierTypeStateIssuer
25806OtherSCSTATE LICENSE
467902058AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060801000246 GA Practitioner - Family Practice 6103891635 Reassigns benefits to 2 organizations
I20200406001665 NC Practitioner - Family Practice 6103891635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Georgia School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

90 E Stephens St
Camilla, GA 31730-1836
Phone (229) 336-5284

97 E Broad St
Camilla, GA 31730-1807
Phone (229) 336-5284

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Associates, P.C. Current Accepting new patients
Murphy Medical Center Inc Current Accepting new patients
Murphy Medical Center, Inc. CurrentSince Mar 31, 2020 Accepting new patients
Murphy Medical Center, Inc. CurrentSince Mar 31, 2020 Accepting new patients
Hospital Authority of Mitchell County Past Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Hospital Authority of Mitchell County Past Accepting new patients
Hospital Authority of Mitchell County Past Accepting new patients

Locations

915 Gordon Ave
Thomasville, GA 31792
Phone (229) 228-8575

145 Medical Park Ln
Ste L
Murphy, NC 28906
Phone (828) 349-3376

183 Ledford St
Murphy, NC 28906
Phone (828) 835-4692

75 Medical Park Ln
Ste D
Murphy, NC 28906
Phone (828) 835-4741

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mitchell County Nursing HomesCamilla, GA, CCN 115266 Skilled nursing facility Adp of the SNF
Indirect Ownership Interest		 Apr 10, 2025
Oct 1, 2009

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 10

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.

Hospital & facility affiliations 12

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": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554854400000",
    "number": "1851345284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "259 US HIGHWAY 19 NORTH",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317301410",
            "telephone_number": "229-336-1949",
            "fax_number": "229-336-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 US HIGHWAY 19 NORTH",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317301410",
            "telephone_number": "229-336-1949",
            "fax_number": "229-336-1436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBENDALL",
        "first_name": "STEPHEN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2019-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "057320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "25806",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "467902058A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camilla, GA

Sources for this page

Verify at the official NPI Registry.