Individual provider Active NPI

Shannon Rose Rodriguez, PA

  • Physician Assistant
  • Temple Terrace, FL
National Provider Identifier
1043796675
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9111385 Issued in FL
Practice address
13020 N Telecom Pkwy
Temple Terrace, FL 33637-0915
Phone
(813) 978-9700
Fax
(813) 558-6185
NPI assigned
Jul 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9111385 FL Primary

Addresses

Primary practice location

13020 N Telecom Pkwy
Temple Terrace, FL 33637-0915

Mailing address

13020 N Telecom Pkwy
Temple Terrace, FL 33637-0915
Phone (813) 978-9700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20181106002715 FL Practitioner - Physician Assistant 2961756176 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cora Health Services IncGroup PAC ID 1759290992, shared by 21 NPIs, 1,125 clinicians

Practice addresses (Care Compare)

1050 Old Camp Rd
Suite 282
The Villages, FL 32162-1762
Phone (352) 693-3378

3334 Capital Medical Blvd
Suite 400
Tallahassee, FL 32308-4470
Phone (850) 877-8174

909 N Dale Mabry Hwy
Florida Orthopaedic Institute
Tampa, FL 33609-1251
Phone (813) 978-9700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9111385FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Musculoskeletal Institute Chartered CurrentSince Jun 6, 2022 Accepting new patients
Musculoskeletal Institute Chartered CurrentSince Jun 6, 2022 Accepting new patients
Tallahassee Orthopedic Clinic III, P.L. CurrentSince Nov 22, 2024 Accepting new patients
Tallahassee Orthopedic Clinic III PL CurrentSince Nov 22, 2024 Accepting new patients
Cardiology Consultants Past Accepting new patients

Locations

11286 Boyette Rd
Ste 101
Riverview, FL 33569

991 E Del Webb Blvd
Sun City Center, FL 33573
Phone (813) 633-5232

3334 Capital Medical Blvd
Tallahassee, FL 32308
Phone (850) 210-1808

2605 Welaunee Blvd
Tallahassee, FL 32308
Phone (850) 219-1932

909 N Dale Mabry Hwy
Tampa, FL 33609
Phone (813) 287-9370

13020 N Telecom Pkwy
Temple Terrace, FL 33637

5901 E Fowler Ave
Ste 100
Temple Terrace, FL 33617
Phone (813) 987-9700

13060 N Telecom Pkwy
Fl Orthopaedic
Temple Terrace, FL 33637

13020 N Telecom Pkwy
Fl Orthopaedic
Temple Terrace, FL 33637

2044 Trinity Oaks Blvd
Ste 110
Trinity, FL 34655
Phone (813) 978-7000

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: shannon.rodriguez.1@18802.direct.athenahealth.com

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1531785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1043796675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13020 N TELECOM PKWY",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336370915",
            "telephone_number": "813-978-9700",
            "fax_number": "813-558-6185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13020 N TELECOM PKWY",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336370915",
            "telephone_number": "813-978-9700",
            "fax_number": "813-558-6185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "SHANNON",
        "middle_name": "ROSE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-17",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple Terrace, FL

Sources for this page

Verify at the official NPI Registry.