Active NPI
Rodd Daniel Whitaker, MD
- Pediatrics Physician
- Enterprise, AL
National Provider Identifier
1083664155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 0000039214
- Practice address
- 101 Professional Lane
Enterprise, AL 36330 - Phone
- (334) 347-3404
- Fax
- (334) 393-0613
- NPI assigned
- May 11, 2006
- Last updated
- Nov 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 0000039214 | AL | Primary |
Addresses
Primary practice location
101 Professional Lane
Enterprise, AL 36330
Mailing address
101 Professional Lane
Enterprise, AL 36330
Phone (334) 347-3404
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009932014 | Medicaid | AL | |
| 51001197 | Other | AL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000039214 | AL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Alabama Medical Center Employee Pharmacy | Past | Accepting new patients | |
| Southeastern Emergency Physicians of Memphis LLC | Past | Accepting new patients | |
| QHG of Enterprise Inc | Past | Accepting new patients |
Interoperability endpoints
- rwhitaker14488@southeasthealth.direct-ci.com
Organizations & group practices 3
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.
-
dba Medical Center Enterprise
- General Acute Care Hospital
- Enterprise, AL
- NPI 1720039712
-
- Pharmacy
- Dothan, AL
- NPI 1053526368
-
- Emergency Medicine Physician
- Alton, IL
- NPI 1437105277
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194566400000",
"number": "1083664155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 PROFESSIONAL LANE",
"city": "ENTERPRISE",
"state": "AL",
"postal_code": "36330",
"telephone_number": "334-347-3404",
"fax_number": "334-393-0613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 PROFESSIONAL LANE",
"city": "ENTERPRISE",
"state": "AL",
"postal_code": "36330",
"telephone_number": "334-347-3404",
"fax_number": "334-393-0613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITAKER",
"first_name": "RODD",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-11",
"last_updated": "2007-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AL",
"license": "0000039214",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009932014",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "51001197",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Enterprise, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.