Individual provider Active NPI

Shirley Rodriguez, DO

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1043506744
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO1864 Issued in NV
Practice address
6850 N Durango Dr
Las Vegas, NV 89149-4595
Phone
(702) 835-9870
Fax
(702) 835-9883
NPI assigned
Jun 22, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X SL0808 NV
Family Medicine Physician 207Q00000X DO1864 NV Primary

Addresses

Primary practice location

6850 N Durango Dr
Las Vegas, NV 89149-4595

Mailing address

2345 E Prater Way Ste 207
Sparks, NV 89434-9634
Phone (775) 356-9393

Other practice location 1

821 N Nellis Blvd
Las Vegas, NV 89110-5339
Phone (702) 438-4003

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20140903001808 NV Practitioner - Family Practice 7416175427 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Las Vegas Medical Group LLCGroup PAC ID 6800118522, 51 clinicians

Practice addresses (Care Compare)

1389 Galleria Dr
Suite 100
Henderson, NV 89014-6686
Phone (725) 333-8400

6850 N Durango Dr
Suite 208
Las Vegas, NV 89149-4596
Phone (702) 835-9870

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO1864NVMDFamily Medicine Physician
SL0808NVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centennial Hills Hospital Medical Center Past Accepting new patients

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 3

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": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1043506744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 E PRATER WAY STE 207",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894349634",
            "telephone_number": "775-356-9393",
            "fax_number": "775-356-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6850 N DURANGO DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891494595",
            "telephone_number": "702-835-9870",
            "fax_number": "702-835-9883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "821 N Nellis Blvd",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891105339",
            "country_code": "US",
            "telephone_number": "702-438-4003",
            "fax_number": "702-438-0555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "SHIRLEY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-22",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "SL0808",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "DO1864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.