Individual provider Active NPI

Rubina Ehtesham, MD

  • Internal Medicine Physician
  • Rockford, IL
National Provider Identifier
1962512152
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036103553 Issued in IL
Practice address
2400 N Rockton Ave
Rockford, IL 61103-3655
Phone
(815) 971-4025
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036103553 IL Primary
Hospitalist Physician 208M00000X 036103553 IL

Addresses

Primary practice location

2400 N Rockton Ave
Rockford, IL 61103-3655

Mailing address

2400 N Rockton Ave
Rockford, IL 61103-3655
Phone (815) 971-4025

Other practice location 1

8201 E Riverside Blvd
Rockford, IL 61114-2300
Phone (815) 971-4066

Other identifiers 1

IdentifierTypeStateIssuer
036103553MedicaidIL

Other names 1

  • Rubina Naseer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20100621000480 IL Practitioner - HospitalistPractitioner - Internal Medicine 9335270222 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rockford Health PhysiciansGroup PAC ID 2567374036, 520 clinicians

Practice addresses (Care Compare)

2400 N Rockton Ave
Rockford, IL 61103-3655
Phone (815) 971-3507

Hospital & facility affiliations

  • Javon Bea Hospital Hospital, Rockford, IL, CCN 140239

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036103553ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
RMH Pathologists, LTD Current Accepting new patients
Rockford Health Physicians CurrentSince Jan 1, 2002 Accepting new patients

Locations

Carol Stream, IL 60122

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310

8201 E Riverside Blvd
Rockford, IL 61114
Phone (815) 971-4066

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

Interoperability endpoints

  • Direct secure messaging: rehtesham48653@direct.mhemail.org

Organizations & group practices 2

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707177600000",
    "number": "1962512152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 N ROCKTON AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033655",
            "telephone_number": "815-971-4025",
            "fax_number": "815-971-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 N ROCKTON AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033655",
            "telephone_number": "815-971-4025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8201 E Riverside Blvd",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611142300",
            "country_code": "US",
            "telephone_number": "815-971-4066",
            "fax_number": "815-971-9299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EHTESHAM",
        "first_name": "RUBINA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036103553",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036103553",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036103553",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RUBINA",
            "last_name": "NASEER",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.