Active NPI
Jason Rodriguez, MBA, LAT, ATC
- Athletic Trainer
- Lake Charles, LA
National Provider Identifier
1124370960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- ATH.200098
- Practice address
- 1747 Imperial Blvd
Lake Charles, LA 70605-5362 - Phone
- (337) 721-7236
- NPI assigned
- Oct 3, 2012
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | ATH.200098 | LA | Primary |
Addresses
Primary practice location
1747 Imperial Blvd
Lake Charles, LA 70605-5362
Mailing address
6832 Calder St
Lake Charles, LA 70605-0163
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)
- Not enrolled
- Credentials
- Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ATH.200098 | LA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732233600000",
"number": "1124370960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6832 CALDER ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706050163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1747 IMPERIAL BLVD",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706055362",
"telephone_number": "337-721-7236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "JASON",
"credential": "MBA, LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-10-03",
"last_updated": "2024-11-22",
"certification_date": "2024-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "LA",
"license": "ATH.200098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.