Individual provider Active NPI

Cristina Frances Rodriguez, PA-C

  • Physician Assistant
  • South Jordan, UT
National Provider Identifier
1043900699
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
141817391206 Issued in UT
Practice address
3556 W 9800 S Ste 101
South Jordan, UT 84095-3221
Phone
(801) 567-9780
NPI assigned
May 8, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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 141817391206 UT Primary

Addresses

Primary practice location

3556 W 9800 S Ste 101
South Jordan, UT 84095-3221

Mailing address

2238 W Temple View LN
South Jordan, UT 84095-8926

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20241024001243 UT Practitioner - Physician Assistant 5799218152 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Copperview Medical Center, LLCGroup PAC ID 4284538976, 18 clinicians

Practice addresses (Care Compare)

3556 W 9800
South Jordan, UT 84095-3211

3556 W 9800
Suite 101
South Jordan, UT 84095-3221
Phone (801) 567-9780

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
141817391206UTMDPhysician Assistant

Organizations & group practices 1

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": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1043900699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2238 W TEMPLE VIEW LN",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840958926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3556 W 9800 S STE 101",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840953221",
            "telephone_number": "801-567-9780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "CRISTINA",
        "middle_name": "FRANCES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-08",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "141817391206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Jordan, UT

Sources for this page

Verify at the official NPI Registry.