Active NPI
Matthew Roderick, O.M.D., L.AC.
- Acupuncturist
- Henderson, NV
National Provider Identifier
1144608290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 2014
- Practice address
- 2675 Windmill Pkwy Apt 421
Henderson, NV 89074 - Phone
- (516) 978-7799
- NPI assigned
- May 8, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 2014 | NV | Primary |
| Acupuncturist | 171100000X | AC 16544 | CA |
Addresses
Primary practice location
2675 Windmill Pkwy Apt 421
Henderson, NV 89074
Mailing address
2675 Windmill Pkwy Apt 421
Henderson, NV 89074-3395
Phone (516) 978-7799
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC 16544 | CA | MD | Acupuncturist |
| 2014 | NV | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531699200000",
"number": "1144608290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2675 WINDMILL PKWY APT 421",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890743395",
"telephone_number": "516-978-7799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2675 WINDMILL PKWY APT 421",
"city": "HENDERSON",
"state": "NV",
"postal_code": "89074",
"telephone_number": "516-978-7799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODERICK",
"first_name": "MATTHEW",
"credential": "O.M.D., L.AC.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-05-08",
"last_updated": "2018-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "NV",
"license": "2014",
"primary": true
},
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC 16544",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.