Olaf Rodriguez, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036171478 Issued in IL

Practice address

1111 W Kenyon Rd
Urbana, IL 61801-1004

Phone

(217) 819-3376

NPI assigned

Mar 21, 2019

Last updated

Jan 29, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, IN, MO, KY4 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 4

Specialty

Dermatology

Education

Perelman School of Med at the University of Pennsylvania, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vitalskin Medical Group Il PLLCGroup PAC ID 5991116261, shared by 2 NPIs, 56 clinicians

Soderstrom Dermatology Center S CGroup PAC ID 2062432651, 31 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Soderstrom Dermatology Center S C

  • Dermatology Physician
  • Peoria, IL
  • NPI 1710931670
  Medicare reassignment Care Compare group
• Vitalskin Medical Group Il PLLC

  • Dermatology Physician
  • Mattoon, IL
  • NPI 1063030252

  MO

  Medicare reassignment NPD
• Vitalskin Medical Group Il PLLC

  • Dermatology Physician
  • New Albany, IN
  • NPI 1477297083

  KY

  Medicare reassignment NPD
• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)
• University of Penn - Dermatology

  • Clinical Medical Laboratory
  • Philadelphia, PA
  • NPI 1003946153
  NPD (past)
• Vitalskin Medical Group Il PLLC

  • Dermatopathology Physician
  • Saint Louis, MO
  • NPI 1881384915
  NPD (past)

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

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1144780594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W KENYON RD",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618011004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W KENYON RD",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618011004",
            "telephone_number": "217-819-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "OLAF",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-21",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036171478",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "IL",
            "license": "036171478",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karima Robinson, RN, BSN, IBCLC
• Walker L Robinson
• Emma Jane Bradbury Robson, MD
• Yasas Rodrigo, M.D.
• Juan Francisco Rodriguez, M.D.
• Hayley E Rogers, APRN, CRNA
• Derrick E Rollo, D.O.
• Lymarie Cristina Rosado Barreras, M.D.
• Roscrance Inc.
• Rosecrance Inc

• Dermatology Physician in Urbana, IL
• Providers in Urbana, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.